Representatives of the American College of Radiology (ACR) urged members of the US House of Representatives Rural Caucus against using radiology benefits managers (RBMs) in the Medicare system and against a proposed imaging equipment utilization rate change from 50% to 95% at a June 24, 2009 Capitol Hill briefing.
Representatives ACR includes Cassandra Foens, medical director of radiation oncology at Covenant Cancer Treatment Center in Waterloo, Iowa, James P. Borgstede, vice chair of radiology at the University of Colorado, and Michael M. Graham, vice chair of radiology and director or nuclear medicine at the University of Iowa.
The three doctors chosen by the ACR and the Access to Medicare Imaging Coalition, joined by representatives from the Lung Cancer Alliance and the Susan G. Komen Advocacy Alliance, highlighted that medical imaging saves lives and saves dollars through earlier disease diagnosis, less invasive medical procedures, shorter hospital stays, and optimized patient treatment.
The doctors advised the members of Congress and congressional staff in attendance that RBMs take decisions out of the hands of physicians and patients, can cause delays in treatment, and form barriers to necessary imaging care for patients. The expert panel also educated attendees that further imaging cuts would have a devastating effect on the ability of physicians in rural areas to continue to provide much needed imaging care to patients.
They discussed the Obama administration’s recent call for the increase in the utilization rate pointing to data recently collected by the Radiology Business Management Association which showed that imaging centers in rural areas operate equipment approximately 48% of the time their offices are open; non-rural centers operate equipment during approximately 56% of their office hours.
The utilization assumption is the percentage of a facility’s operating time that the equipment is assumed to be in use and is a key component of the Medicare formula used to calculate reimbursement. If the assumption is dramatically higher than the actual time a facility’s machines are in use, the center will be significantly underpaid for their services.
A 90-95% utilization rate for CT and MRI scans, the doctors argued, would result in an additional 30+% reimbursement cut for these modalities, on top of an average 23% hit resulting from imaging provisions in the Deficit Reduction Act of 2005 and even more reductions called for in the CMS’ proposed Physician Fee Schedule Rule.
With cuts this deep, there will be minimal if any access to advanced imaging in rural America. Even suburban and urban providers may find it hard to continue to offer the same level of service — all leading to longer travel for care and longer wait times.
The ACR will continue to work to educate lawmakers that imaging and radiation oncology reimbursement policies must be based on scientific data and not arbitrary cost cutting. The College will continue to keep members informed of any developments as health care reform legislation moves forward.