A Medical Device Daily

The subject of the amount of money spent on Medicare imaging in doctors' offices continues to be a chart-topper, and the recent Government Accountability Office report dealing with this subject did not disappoint in this context, drawing quick and vehement response from industry. The report indicated, however, that beneficiary access was not hampered, a fact that did not seem to mollify critics of the policy, some of whom had previously argued that access would indeed be problematic.

The topic has not avoided the scrutiny of the Medicare Payment Advisory Commission (MedPAC), which recently heard testimony that Congress should allow the Centers for Medicare & Medicaid Services to require pre-authorization to tamp down on the overuse of the various imaging modalities (Medical Device Daily, Sept. 9, 2008). Nonetheless, MedPAC members seemed disinclined to pass along such a recommendation to Congress.

The Sept. 26 GAO report noted that total Medicare Part B expenditures "are expected to increase over the next decade at an average annual rate of about 8%," a good deal faster than the projected growth of gross domestic product of 4.8%. GAO also noted the 13% annual growth rate in Part B imaging between 2000 and 2006, "from about $7 billion to about $14 billion." Two thirds of Part B imaging is said to have taken place in a physician's office.

The report said that the aligning of technical fees for physician office imaging to hospital outpatient department fees embodied in the Deficit Reduction Act of 2005 (DRA) "sparked intense reaction from the imaging provider community," which argued that access could suffer. However, the GAO report indicated this was not the case. Technical fees are those charged for performing scans, not for interpreting scans.

GAO examined changes in Part B imaging that took place between 2006 and 2007, and concluded that imaging spending "fell to $12.1 billion, a decline of 12.7% from 2006." All the same, the report noted "an increase in per-beneficiary volume of imaging services," which was not enough to offset the reduction in overall imaging spending. This came at a time when the number of beneficiaries under fee-for-service declined by 2.5%, but "the volume of tests increased from 1.99 to 2.05" per beneficiary.

Regarding the GAO report, acting CMS administrator Kerry Weems wrote a Sept. 12 letter to Vincent Ventimiglia, Jr., the assistant secretary of legislation at the Department of Health and Human Services that neither industry nor MedPAC have been able to "definitively explain the growth and geographic variation in imaging spending." Weems also suggested that the rapid increases in such imaging and the geographic variation "raised questions about whether such growth is appropriate and whether all imaging services are used appropriately."

Weems also said that CMS is "pleased that GAO's findings suggest that overall beneficiary access ... was maintained under the DRA payment system."

As one might expect, industry took a less favorable view. In a Sept. 30 statement, Stephen Ubl, president of the Advanced Medical Technology Association (AdvaMed; Washington) described the DRA reduction in fees as "draconian" and made the case that "the use of advanced imaging – used to detect and guide physician treatment decisions for cancer and heart disease, both deadly and pervasive diseases – is slowing." However, Ubl did not address the question of whether access had been affected.

The American College of Radiology (ACR; Reston, Virginia) took a similar tack in a Sept. 30 statement by James Thrall, MD, chairman of ACR's board of chancellors, who said the effect of the DRA cuts ran "far deeper than the Congressional Budget Office (CBO) initially stated" and that ACR "supports recent legislation passed by Congress to curtail inappropriate utilization of imaging studies by implementing mandatory accreditation of imaging providers."

However, ACR previously made the argument that access was an issue. In an undated statement obtained from the ACR website, Arl Van Moore, MD, the previous chair of the ACR board of chancellors said Congress ought to repeal the DRA provisions "before these drastic cuts irreparably damage patient access to care."

ACR spokesman Shawn Farley told Medical Device Daily that accreditation of imaging centers would help blunt overuse because it would work with appropriateness criteria because accredited clinics are more likely to use appropriateness criteria. "The thing we think is not helpful is these across-the-board imaging cuts that put everyone in one boat," Farley said, adding "when people have applied [appropriateness] criteria, it has turned out that" inappropriate imaging went down.

FDA to boost funds for agency IT systems

Those who are of the opinion that FDA's information technology infrastructure is stuck in the 20th Century have not exactly heard a lot of dissent, and the agency reported Tuesday that it has come up with funds totaling roughly $2.5 billion to bring its IT operations up to par.

The Sept. 30 announcement states that the funds will be spent over a span of a decade and will require the efforts of ten contractors toward that end. Billed as the Information Technology for the 21st Century (ICT21) bioinformatics initiative, the program will upgrade data management and warehousing as well as security systems.

FDA commissioner Andrew von Eschenbach, MD, said the agency is "creating a high-tech, efficient, data management system designed to meet the needs of those who must accomplish our mission – protecting and promoting the health of the American public."

Among the funds already awarded is a $3 million contract to Buccaneer Computer (Warrenton, Virginia) for "operations and maintenance" of the agency's data center at its campus in White Oak, Maryland, and an identical amount to IT Solutions (Silver Spring, Maryland) for the design and implementation of testing and development computer systems in addition to migration of existing data files to the White Oak data center.