2012 Renews Reimbursement Focus for Radiology

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Cynthia MoranAs another congressional session progresses, lobbyists representing radiology organizations on Capitol Hill have their sights set on preventing further cuts to imaging services under Medicare, especially as debate intensifies over fixing the sustainable growth rate (SGR) formula.

On February 17, Congress passed a measure freezing Medicare reimbursement at 2011 rates for the rest of 2012, preventing the 27.4% automatic SGR cut from taking effect on March 1. This 10-month reprieve was not far from the one-year extension predicted by many industry analysts, including Cynthia Moran, assistant executive director for government relations and health policy for the ACR®. Momentum for big changes to Medicare (such as permanently fixing the SGR problem) is more likely following the election in November, no matter which party ends up on top, Moran says.

Election Impact

A divided Congress has prevented several Medicare physician pay cuts in recent years, but it’s going to take the will of both parties to alter Medicare drastically, Moran says. Republicans might be generally more receptive to reforming the federal program, but even if President Obama retains the White House and Congress remains divided, Moran says, she feels the pressure mounting to do something major. “If the current president put that on the table, the way the Congress is now, you could get some large bipartisan support for revamping the program,” Moran says.

Congress has put off addressing the SGR for so long because large-scale changes to Medicare are threatening to groups representing the elderly, Moran says. The debate in Congress could very well be more heated than it was for health-care reform.

“We’re hoping that stronger minds will prevail and sanity will kick in,” Moran says. “At some point, the program has to be revamped and modernized because it’s unsustainable. You can’t keep cutting physician fees and expect there’s going to be anything worth giving the beneficiary. We’re not going to be able to sustain Medicare unless people are willing to rethink the premise behind it.”

Bob Still, MD, president-elect of the RBMA, says that a more permanent repair of the SGR method is a big issue for radiologists (and physicians in general) this year. “I’m not sure if it’s going to get tied up in the year-end budget, a debt-ceiling deal, or whatever they’re going to call it as we get closer to the election,” Still says, “but it’s a huge, overriding deal for all physicians.”

Still believes that there will be other approaches this year aimed at lowering reimbursement on advanced imaging. The industry should be on guard, he says, for changes such as an increase in the required utilization rate for advanced imaging equipment. “There will also be a refocus on meaningful use in radiology and possibly some corrections for hospital-based physicians,” he says.

Discussions with the US DHHS Office of the National Coordinator for Health IT took place in 2011 over how, exactly, to define a hospital-based physician—because the meaningful-use definition was thought to exclude many radiologists from electronic medical record (EMR) subsidies. The final rule, however, clarified that radiologists qualify for the EMR bonuses if at least 10% of their services are rendered to outpatients.

Still suggests that Congress should look into other areas of diagnostic imaging that might not affect radiologists, such as the in-office ancillary exemption to self-referral regulations. “You have to remain hopeful that at some point, Medicare regulators and Congress will take radiology out of their sights as an area to cut,” Still says. “I feel that radiology has given its fair share, over the past several years.”

Gathering Steam

Many of 2011’s regulatory battles have carried over into 2012, Moran says. “We had to battle Capitol Hill to keep further cuts out of any health-care package that was going to go through,” she notes, “and we had to battle CMS, which was going through its own payment reductions.”

As part of opposing Medicare’s Multiple Procedure Payment Reduction (MPPR) and its extension to the professional component, the ACR organized a write-in campaign that solicited 7,000 comments to CMS. “We screamed and hollered,” Moran says, calling the MPPR baseless.

Now, the ACR and its team of six lobbyists are working to block further cuts in the form of the MPPR permanently, through a bill now in the House. Specifically, HR 3269 (the Diagnostic Imaging Services Access Protection