Attention, All Campers

Much has been said and written about the significant economic effect the Deficit Reduction Act of 2005 (DRA) will have on the imaging industry. For many, imaging expansion plans have been stopped, development or equipment sales departments have been downsized, and equipment purchases and upgrades have been placed on hold or cancelled. Considerable human and economic resources have been expended to publicize what, quite literally, happened in the dark of night in Washington, DC. Activities are underway to analyze the DRA’s full effect while seeking ways to change it—or, at least to lessen its damaging effects. From a business perspective, the imaging industry seems to have divided itself into three camps. The It-Can’t-be-That-Bad camp is comprised of organizations that have chosen a wait-and-see position related to the DRA and specifically to its impact on their business. These campers include some physicians, imaging centers, and developers of software, equipment, or pharmaceutical agents. This camp appears unconcerned about the looming vulnerability the imaging industry faces with a possible additional DRA proposal in 2006. Additional cuts are currently being contemplated in Washington, DC, as a fix is sought for mitigating the upcoming, scheduled -5.1 percent adjustment to the physician fee schedule. The previous “SGR fix” is what led to the imaging cuts included in the DRA of 2005. The Woe-Is-Me camp complains about the federal government and the manner in which decisions are made, with little belief in their own or their organization’s ability to advocate for (or influence) change. It is my opinion that the public servants in the nation’s capitol are better able to serve/vote if they are given information from the real world. The Let’s-Roll-Up-Our-Sleeves-and-Work-Together camp is an exciting place for those who like close-to-impossible odds. Working with the National Coalition for Quality Diagnostic Imaging Services (NCQDIS), the equipment manufacturers, several medical specialty societies, and various other groups, we have done what we were advised was impossible to do: introduced bills in both the Senate (S.3795) and the House (H.R.5704) placing a moratorium on the DRA imaging cuts. Last January, we were advised by many Washington insiders that no Republicans would sign on to such a bill because the administration and Congressional leadership would pressure them to leave it alone. We were also told that, in this election year, Democrats and Republicans would not go on the same bill with each other. That we have proven the pundits wrong is a testament to our elected officials’ willingness to listen and the hard work of the Roll-Up-Our-Sleeves camp. During the first week in September, we topped 90 House co-authors. There is a detailed story to be told about how each one of these co-authors was persuaded to sign on the bill. Always, it includes contact with a constituent(s) who will be directly affected by the DRA. Although none of us expect the DRA moratorium bill to pass as a separate bill, we are working to see that the language of it is included in any Medicare or health appropriations bill that comes up between now and the end of the year. This is a daunting goal, but well worth the attempt because of the ramifications if we are not successful. Speaking of ramifications, everyone in the imaging industry should also be a member of the most important group: the What-About-Our-Patients camp. All of us in the imaging industry should be blowing our horns, banging pots and pans, and generally making a big ruckus of righteous indignation related to how the DRA legislation will impact our patients. Whether your company manufactures a contrast agent, develops PACS software, builds faster or higher strength machines, or is an IDTF or physician practice, the ultimate recipients of our services are those who will be most affected. For example, our patients at CDI include the grandfather who noticed a motor-skills delay when placing nickels in a slot machine at a Minnesota casino. Stroke was suspected, but the MRI with and without contrast indicated metastasized cancer. The DRA cuts that procedure by 49 percent. What would a two- or three-week delay in diagnosis have meant to this patient and his family, considering he began treatment within 24 hours of his MRI? Why would we want a public policy that potentially delays this type of care for our elderly patients through the elimination of quality providers? What about the farmer, who has a $5,000 deductible with his health plan, whose son needed a spine MRI because of a football injury? The farmer called three facilities, all within 30 miles, to check on costs of the MRI and found a quality facility that was charging less than the local hospital. If some imaging centers close their doors, especially those in less-populated areas, then what will the farmer pay for his son’s scan in another year? The under-insured and uninsured will be affected as significantly and as quickly as our Medicare beneficiaries by this law. And what about imaging quality for all of our patients? In a capital-intensive industry, cutting reimbursement will erode quality, not lessen utilization. While MedPAC and CMS staff design pay-for-performance funding programs, they are mandated to implement an irrational reimbursement policy that ignores whether the scan is done on a 25-year-old, poorly calibrated MRI or on an ACR-accredited machine. The DRA does not recognize any of the government’s own findings regarding patient-centered care and the need to focus on safety, effectiveness, timeliness, efficiency, and equity. Nor does it require basic utilization checks such as written orders or standards for those who interpret the images. Because the DRA was obviously “all about the money,” we must communicate our concerns about our patients, to our colleagues, and to members of Congress. Recently, the Access to Medical Imaging Coalition (AMIC) has set up a Web site that makes it easy to make Congressional contact. The Web site is: www.imagingaccess.org. Just click on “TAKE ACTION NOW.” If you have already made contact with your Congressional delegation, please do it again. We still need more authors for the DRA moratorium bill. The daunting challenge before us is also a time of growth for our industry, spurring us to organize and pool our precious resources. It also offers us a chance to educate policy makers and the public about an area of medicine that is fantastically exciting, with unimaginable future potential. I look forward to what lies ahead for us.