Policy reforms in Washington that will impact nuclear imaging

Improved reimbursements for radiopharmaceuticals

A significant breakthrough has been the Centers for Medicare and Medicaid Services' decision to appropriately reimburse high-cost radiopharmaceuticals. Previously, these pharmaceuticals were bundled with supplies, leading to inadequate reimbursement rates.

"The reimbursement was really not appropriate for some radiopharmaceuticals," she said. "Hospitals obviously don't want to go under and supply a pharmaceutical that they're not going to get proper reimbursement for. This is particularly true in rural areas or in areas where we serve minority populations,"

Recently, CMS said it will cap the radiopharmaceutical payment at $630, and anything above that costs more than that per day Cutler added. 

"This means that patients will now have access to what we call 'high value radiopharmaceuticals,'" she said. "Companies now see that doing innovation in this area is important and they can make a business case that these are radiopharmaceuticals we should be developing. We've heard from companies that they're now changing their strategic plans based on the fact that the CMS made this change."

While this is a positive change, it took SNMMI 10 years to get CMS to consider the policy update. Originally, SNMMI was pushing for the passage of the Facilitating Innovative Nuclear Diagnostics (FIND) Act, which has similar language to what CMS adopted. Cutler said Congress ended up pushing CMS, asking the agency to look into this issue and  and make the change.

Find It Early Act would ensure access to advanced breast imaging

Another key legislative focus is the Find It Early Act, which aims to eliminate out-of-pocket expenses for supplemental breast cancer screening, including specialized nuclear imaging technologies like PET and SPECT to visualize the metabolic activity of tumors. Women, especially those with dense breasts, are often denied coverage for advanced imaging. They still have access to this technology, but they need to pay out of pocket. Most women cannot afford the extra charge and may settle for the less effective imaging that is covered by insurance.

“Women facing breast cancer should not bear the financial burden of additional screenings essential for tailored treatments,” Cutler said. Efforts to reintroduce and pass the legislation will continue in the new Congress in 2025.

Protecting licensing standards and expanding research funding

Cutler also underscored SNMMI's advocacy to preserve licensure for nuclear medicine technologists, ensuring quality care for patients.

Additionally, SNMMI has collaborated with the Department of Defense to include nuclear medicine in its medical research funding, notably for neuroendocrine tumors.

Addressing NIH reform and physician fee cuts

Amid discussions about National Institutes of Health reform, Cutler expressed concern over potential funding reductions for imaging research through the National Institute of Biomedical Imaging and Bioengineering. Cutler said there have been discussions about no longer looking at disease-specific cases, but SNMMI's biggest concern is if reformers decide to get rid of NIBIB. She said it is one of the agencies that consistently provides funding, particularly for imaging and imaging agents.

"We're very concerned that if that goes away, we will end up with a lot less funding to help provide these new agents," she said. 

Medicare reform needed as cuts start to impact access

Cutler also highlighted the detrimental impact of cuts to the 2025 Medicare Physician Fee Schedule on nuclear imaging providers, especially in rural communities. “We must ensure adequate reimbursement to sustain these vital practices,” she urged.

She cited the American Medical Association figure that Medicare physician payments have decreased by 29% since 2001, when adjusting for inflation. Most businesses could not sustain those levels of cuts while overhead continues to climb. Cutler said some imaging centers are starting to close because Medicare does not pay enough to cover the cost of doing business. As cuts continue without Congressional reforms, patient access will be reduced as imaging locations close, or physicians decide to stop accepting Medicare. 

As SNMMI continues its advocacy efforts into 2025, Cutler said the organization remains committed to fostering innovation and accessibility in nuclear imaging, ensuring that all patients benefit from cutting-edge diagnostics and treatments.