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A letter signed last week by some 30 medical societies, technology associations, healthcare providers and patient advocates has asked congressional leaders to reconsider the cuts made in medical imaging services for Medicare beneficiaries in the Deficit Reduction Omnibus Reconciliation Act of 2005.

Among other points, the letter said Section 5102 of the act “would significantly cut Medicare reimbursement for the provision of diagnostic and interventional imaging services.“

It added: “These life-saving diagnostic services are performed by a wide array of physician specialties in their offices and in freestanding imaging centers. This provision singles out imaging services to absorb over one-third of all the Medicare payment reductions in the DRA.“

In the letter, sent to House and Senate leaders, the group said: “We are particularly concerned that these cuts were included without any public deliberation by either body of the Congress. There has been no analysis of the potential impact of this change in payment policy, and we fear that these cuts will have numerous unintended consequences, including potentially diminishing access to imaging services outside the hospital setting.“

It added: “We ask that you work with us and the committees of jurisdiction on this issue to fix this new provision in the law prior to its implementation in January 2007.“

The letter was sent by the National Electrical Manufacturers Association (Rosslyn, Virginia), with other signatory groups representing more than 75,000 physicians, in addition to organizations that employ tens of thousands of individuals. Copies were sent to Speaker of the House Dennis Hastert and the majority and minority leaders in both the House and Senate, with copies to key committees.

The signers of the letter included the Academy of Radiology Research, Academy of Molecular Imaging, American College of Radiation Oncology, American College of Radiology, American Society for Therapeutic Radiology and Oncology, Society for Vascular Surgery, Society of Interventional Radiology and Society of Nuclear Medicine.

Among the other groups was the Advanced Medical Technology Association .

Homecare group raps recommended freeze

The American Association for Homecare (AAHomecare; Alexandria, Virginia) has questioned the recommendation in the Medicare Payment Advisory Commission's (MedPAC) “March 2006 Report to Congress“ to freeze Medicare payment rates in 2007 for the nation's 7,300 home health agencies.

The organization said the proposed cut, if enacted by Congress, would come on top of negative marketbasket updates for home health agencies in each of the last five years.

“For MedPAC to suggest anything that continues to undercut the financial underpinnings of the home health benefit is simply beyond the pale at a time when the first wave of the baby boomers will begin retiring in the next 18 months and will be depending on Medicare,“ said Sue Mairena, chief operating officer of AAHomecare.

She added: “Simply put, the freeze is unwarranted, unjust and unsound.“

AAHomecare said it believes that the MedPAC home health freeze recommendation is based on two “critically flawed“ assumptions – distorted margin data and overstated sector growth.

On the former, the association said MedPAC “continues to base its annual update recommendation on only part of the homecare sector by excluding all hospital-based home health agencies.“

Yet, it said in a statement that hospital-based agencies represent a full 25% of the total sector, according to data from the Centers for Medicare & Medicaid Services (Baltimore).

AAHomecare said that similarly, MedPAC gives “disproportionate weight“ to large home health agencies (HHAs) with higher profit margins through utilization of a weighted methodology rather than a method that gives equal weight to all providers.

“There is no statistically sound reason for either of these actions on the part of MedPAC,“ the association said in its statement.

As for overstated sector growth, the group said, “one of the principal underpinnings of MedPAC's recommendation for a freeze in the payment rate is the recent growth in the number of Medicare home health agencies nationwide.“

The organization said that between 2003 and 2004 the total number of home health agencies grew by a net total of about 335, “representing growth of less than 5% nationally.“ But virtually all of that growth, it said, came from two states, Florida and Texas, together accounting for 395 new agencies.

AAHomecare said 28 states saw a decline in the number of HHAs, seven had no change, and the remaining 15 had “fractional“ increases.

Mairena said, “Federal policymakers should be looking for ways to support this program. The home health benefit is clinically effective, patient-preferred and cost-effective, as evidenced by recent data from the Medicare program itself.“

The group said a Rand Corporation study commissioned by MedPAC found that the cost for joint replacement patients treated at home was some $3,500 less than for patients discharged to a skilled nursing facility and $8,000 less than for those sent to inpatient rehabilitation facilities. A panel of 11 physicians said, “Ideally patients with hip or knee replacements should go home for rehabilitation.“

AAHomecare said “the great majority of Medicare beneficiaries choose to receive care at home when possible, and said it “will continue to work with the Congress to prevent future cuts to this critical Medicare benefit.“

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