Congress reconsiders controversial changes to radiologist assistant payments

Members of Congress have brought back controversial legislation that would help broaden payment pathways for radiologist assistants. 

U.S. Sens. John Boozman, R-Ark., and Ben Ray Luján, D-N.M., on Thursday reintroduced the Medicare Access to Radiology Care Act, commonly referred to as MARCA. Previously proposed in multiple years past, MARCA would allow physicians to submit claims to Medicare for nondiagnostic services performed by registered radiologist assistants directly supervised by docs. 

Rad tech advocates say the bill would help relieve staffing shortages, letting assistants perform procedures such as needle placements, biopsies and injections that accompany imaging studies. This would allow radiologists to focus on their core image-interpretation duties.

“Medicare patients should not go without access to important diagnostic tools, either because of a lack of available personnel or red tape,” Boozman said in a statement shared Dec. 12. “Radiologist assistants are well qualified to fulfill this need, and our bipartisan legislation would ensure they can do so. Allowing Medicare coverage for these procedures is common sense and will help deliver timely and quality care.” 

Boozman proposed the same bill in 2021, with some radiologists voicing their opposition at the time. Medicare changed its rule in 2018 so that registered radiologist assistants could perform certain services under the direct supervision of radiologists. However, radiology providers were left unable to submit claims to Medicare for this work when performed in hospital or office settings. (Boozman noted Thursday that this was partially adjusted in 2019, allowing RAs to submit claims when performing supervised work in physician offices, but not hospitals.) Radiologists expressed concern three years ago that MARCA could lead to technologists gaining greater independence and taking more work from physicians. 

“What’s not tenable is acting as though scope creep won’t happen just because it’s not permitted in the initial expansion law,” Texas neuroradiologist and blogger Ben White, MD, said in 2021. “Paper is cheap. People on the slippery slope never believe it until they slip further than intended. Predicting consequences is a hard business.” 

The American College of Radiology said at the time it would remain neutral on the legislation, given a diversity of opinions in its membership. ACR did not respond to Radiology Business requests for comment on Thursday and Friday. However, the college earlier this year affirmed its support for the registered radiologist assistant as a valuable member of the imaging team. To become an assistant, individuals need to have worked with radiologists since starting their training as a radiographer. Clinical RA education typically is completed under the preceptorship of a member of the specialty, ACR noted.

Both the American Registry of Radiologic Technologists and the American Society of Radiologic Technologists celebrated the bill’s reintroduction Thursday. ASRT said the legislation will help ensure that all services provided by assistants (and supervised by radiologists) will receive Medicare reimbursement, regardless of setting. The U.S. is experiencing a “major shortage” of imaging professionals, ASRT emphasized, and the country must promote the valuable role of assistants. 

“It is critical that obstacles are removed to provide this essential healthcare professional with career advancement opportunities,” ASRT CEO and Executive Director Melissa B. Pergola said in a separate statement.

The Radiology Business Management Association has not taken a stance on the legislation. However, Co-executive Director Linda Wilgus, MBA, said the organization “looks forward to reviewing the legislation” and “collaborating with ARRT and ASRT on addressing critical workforce shortages.” Meanwhile, imaging groups such as Wellspring Capital Management-backed Rayus Radiology have endorsed the proposal.

Currently, 33 states license, certify or recognize radiologist assistants, and Rayus relies on their expertise in multiple markets. 

“Recognizing the RA in the Medicare program would enable radiology practices to become more efficient and will help to ensure patients have access to care provided by qualified healthcare personnel,” Kit Crancer, senior VP of radiology partnerships and public policy for the Minneapolis-based group, wrote to members of Congress in June. “With demand for high-quality radiology services continuing to increase while workforce challenges remain pressing in our state, passing MARCA represents a meaningful step towards improving the lives of Medicare beneficiaries.”