Caution Ahead: Keep Your Eyes on the Road

While driving a car, if you constantly look in the rearview mirror, it exponentially increases your chances of getting into a wreck. The imaging industry was able to beat back more than a billion dollars’ worth of cuts in Medicare in a bill that President Bush signed into law on December 30, 2007. Those cuts were originally included in a House-passed bill (HR 3162, the Children’s Health and Medicare Protection Act) intended to slash payments to Medicare providers, including $1.2 billion for imaging services . Thanks to the efforts of dedicated advocates, however, the cuts were dropped at the last minute. In the bill that Congress passed and that Bush signed, physicians were spared a 10% payment cut and granted a 0.5% positive update, but only for 6 months. Congress must once again revisit an even larger cut—of perhaps as much as 12%—by June or face the political wrath of the physician community. Now, though, we need to change our perspective toward what might happen on the road ahead and the dangers that lurk in 2008 for advanced diagnostic imaging. In an election year, it is politically unlikely that Congress will balk and will therefore provide another physician-payment fix. Under the new pay-as-you-go (or PAYGO) budget rules, however, new spending must be offset; this means that everything is on the table, including payment reductions to hospitals, long term care facilities, home health care providers, and, yes, imaging. New studies—either recently released or about to be released—portend dark clouds on the horizon that might provide deadly ammo for a Congress that needs to pay as it spends. Already, an OIG report has caused suspicion on the Hill about increased imaging spending. The report finds that four of the same five codes are still in the top five after the 10 years analyzed. Unfortunately, the report is a blunt instrument that doesn’t take into account the massive $8-billion reduction in Medicare spending for imaging services. It also fails to highlight substantial growth in areas where physicians can refer patients to the machines that they own. In addition, the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) are conducting separate inquiries into imaging services, and it is unclear what conclusions they will reach. Combined, the studies might provide Congress with cover to make additional cuts. Deep cuts will make it difficult for many imaging centers to keep their doors open, and will also have a negative impact on the availability of high-quality care. Imaging companies will be forced to make tough decisions, such as no longer investing in state-of-the-art equipment, reducing access to care, or closing their centers. These decisions are sure to have a particularly devastating impact on patients, especially those in rural areas, if Congress moves forward with more spending reductions. That is why the Association for Quality Imaging (AQI) is fighting back. AQI represents more than 2,400 independent diagnostic imaging facilities and vendors across the United States. Our mission is to advocate for diagnostic imaging, to educate policymakers and lawmakers on the value and importance of our members, and to lobby for our agenda of safety, quality, and appropriate utilization. We have met with MedPAC and GAO. We are countering the OIG study in meeting after meeting on Capitol Hill. After nearly 12 years on Capitol Hill, the last as staff director of the Ways and Means Health Subcommittee, I came to appreciate deeply that one way to avoid a negative outcome is to provide a positive alternative. It is not enough simply to say, “No new cuts.” That is why AQI is not only saying, “No new cuts,” but is offering new solutions in quality and safety standards for all Medicare providers, regardless of setting. In addition, we are pointing out those inappropriate arrangements that may be at the crux of the increases in imaging spending. We are also educating members and staff about the paucity of information on the impact of the $8 billion in cuts mandated by the Deficit Reduction Act. While we are fighting back, we cannot do it alone. We need all facilities to join the battle by joining AQI.