ACR, others push for imaging-agent pay fix as House leaders plan hearing on topic
The American College of Radiology and three other advocacy groups are urging the federal government to strengthen payment for diagnostic imaging agents. Meanwhile, leaders of the U.S. House are planning an upcoming hearing on related legislation.
ACR et al. pleaded their case to the Centers for Medicare & Medicaid Services in comments submitted to the feds on Monday. They noted that radiopharmaceuticals play an essential role in diagnosing difficult-to-pinpoint diseases such as Alzheimer’s Parkinson’s and prostate cancer.
However, the way in which the agency currently reimburses for these critical drugs is impeding care delivery, they contend.
“Diagnostic radiopharmaceuticals are not interchangeable and substitutions with conventional imaging can impact patient care,” ACR et al. wrote to Administrator Chiquita Brooks-LaSure on Sept. 11. “CMS’s decision to ‘policy package’ diagnostic radiopharmaceuticals creates a disincentive for hospitals with outpatient imaging service lines to utilize the most innovative diagnostic radiopharmaceuticals because they are not adequately reimbursed through the [outpatient prospective payment system] which impacts patient care.”
The comments come in response to a July request for comment from the agency, which is exploring the possibility of issuing separate payment for such diagnostic imaging agents. Others signing the comment letter included the Council on Radionuclides and Radiopharmaceuticals, Medical Imaging & Technology Alliance, and the Society of Nuclear Medicine and Molecular Imaging.
Bipartisan members of the U.S. House and Senate introduced companion bills earlier this year to address this longstanding issue. The Facilitating Access to Innovative Diagnostics (or FIND) Act would eliminate this obstacle by requiring HHS to issue separate payment for such imaging agents, using a per-day cost threshold of $500.
The House Energy and Commerce Committee announced Tuesday that it plans to hold a hearing to discuss the FIND Act, among other policy proposals. Slated for Sept. 19 at 10 a.m. Eastern Time, the hearing is titled “Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology.”
“Millions of Americans rely on Medicare to access lifesaving and life-sustaining treatment and care,” Committee Chair Cathy McMorris Rodgers, R-Wash., said in a Sept. 12 announcement. “Despite the importance of the program, some of its outdated policies and procedures leave many of our seniors with fewer options or unable to receive the most innovative and effective means of care.”
In their comments to CMS, the four groups contended that continued use of CMS current policy will lead to “diminished patient access” while discouraging the use of cutting-edge imaging.
“To ensure that patients have access to the best diagnostic radiopharmaceuticals in readily accessible healthcare settings, we strongly urge CMS to separately pay for diagnostic radiopharmaceuticals which exceed a specified threshold,” ACR et al. wrote. “This will ensure that patients have access to the most sophisticated diagnostic radiopharmaceuticals and receive the most medically appropriate treatment plan.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.