Medical Device Daily Washington Editor
WASHINGTON — While healthcare information technology has commanded much of the healthcare attention on Capitol Hill, some members of the House are still examining the impacts of the Deficit Reduction Act of 2005 (DRA), which President George Bush signed into law this past February.
In that vein, Rep. Joe Pitts (R-Pennsylvania) introduced H.R. 5704 on June 28, a bill that would impose a two-year moratorium on reductions in Medicare payments for imaging services. However, the information on which Pitts based his bill may prove to be less than statistically reliable.
According to a letter addressed to Speaker of the House Dennis Hastert (R-Illinois) authored by Pitts, the proposed cuts embodied in the DRA would “lead to reimbursement reductions of upwards of 30% to 50% for imaging services that patients and their physicians rely on to properly detect, diagnose and treat life-threatening conditions.”
Pitts argued that a two-year delay would “give Congress a chance to fully understand how cuts of this magnitude could affect Medicare beneficiaries' access” to such services. The outpatient procedures addressed are those taking place in both doctors' offices and stand-alone imaging centers.
Pitts' May 10 letter to Hastert charged that Congress did not engage in an “analysis of the impact this change in payment policy will have on Medicare beneficiaries' access to imaging services,” potentially resulting in “higher co-pays and increased wait times and travel times to receive imaging services.”
H.R. 5407, titled the “Access to Medicare Imaging Act of 2006,” calls for “a budget-neutral, two-year moratorium” by amending section 5102 of the DRA by replacing the year 2007 with the year 2009. Pitts' bill also calls on the Gov-ernment Accountability Office (GAO) to conduct “a comprehensive study on patient access and services issues” related to the Medicare payment reductions in question, specifically looking at “rural and medically underserved areas” as well as “the appropriateness of using the hospital outpatient department prospective payment system methodology to set reimbursement under the Medicare program for all imaging services, regardless of the site of service.” If passed H.R. 5704 would require that GAO complete such a study by July 31, 2008.
The co-signers of Pitts' letter, which includes Reps. Christopher Shays (R-Connecticut) and Charles Boustany (D-Louisiana), make the case that “[r]educed access to imaging in the physician's office will increase” wait times experienced by those seeking non-urgent imaging services and will erode the cost savings to beneficiaries by seeking such services outside a hospital. The letter states that a cranial CT scan without contrast typically incurs a co-pay of less than $40 in a free-standing imaging center, but that the cost “doubles to $75” when using a hospital's outpatient imaging center.
Reaction to the bill has been predictably positive in the provider community. Arl Van Moore, MD, who chairs the board of chancellors for the American College of Radiology (ACR; Reston, Virginia), said that “Congress needs to take a closer look at how the arbitrary cuts in the Deficit Reduction Act will adversely affect access to care nationwide.” Van Moore lauded Pitts and his co-signers, remarking that the GAO study would “allow for the creation of a more thoughtful and ultimately more effective approach to these services which will protect access to care and allows doctors to provide the highest quality care to their patients.”
In a March 1 letter to a number of members of Congress, the Access to Medical Imaging Coalition, spearheaded by ACR and the National Electrical Manufacturers Assoc-iation (NEMA; Rosslyn, Virginia), said that Congress did not evaluate “the potential impact of this change in payment policy,” and expressed concern that “these cuts will have numerous unintended consequences, including potentially diminishing access to imaging services outside the hospital setting.”
The letter said that the coalition represents more than “75,000 physicians and numerous major organizations who employ tens of thousands of citizens” and that they are “united in our opposition to the language in Section 5102 of the DRA.” ACR and NEMA are credited with having teamed up to form the Access to Medical Imaging Coalition.
Estimates of the impact of the DRA reduction in imaging spending vary widely. The Congressional Budget Office pegged the savings to Uncle Sam at $2.6 billion over five years, but according to the Society for Interventional Radiology (SIR; Fairfax, Virginia), the reduction in payments could tally up to $6 billion over five years. According to its web site, SIR is “currently assessing these cuts and also working with a broad coalition to determine the impact to SIR members and to patient care.”
According to his letter, Pitts and his co-signers based their arguments on “an initial pilot survey” conducted by the Society for Vascular Ultrasound (SVU; Lanham, Maryland). One of the difficulties with the survey, according to SVU's executive chair of government relations, Bill Schroedter, is that the survey drew only about 20 responses, a number smaller than is often felt necessary to impart inferential power to surveys. Nonetheless, Schroedter told Medical Device Daily that “[w]hile the survey is based on small numbers, we feel that it is fairly representative of what's going on based on feedback from our members.”