The Society of Nuclear Medicine and Molecular Imaging (SNMMI), along with more than 80 stakeholder organizations, celebrated the introduction of H.R. 1199, the Facilitating Innovative Nuclear Diagnostic (FIND) Act of 2023, on February 27 by Representatives Neal Dunn (R-FL), Scott Peters (D-CA), Greg Murphy (R-NC) and Terri Sewell (D-AL).

Many in the industry have become familiar with the FIND Act over the last few years, but what exactly does it do? HCB News sat down with Dr. Munir Ghesani, president of SNMMI, to get some insight into why so many nuclear medicine insiders are excited about the bill's implications.

HCB News: The FIND Act is meant to ensure patients have access to the best radiopharmaceuticals and nuclear medicine diagnostics and treatments. How does it do that?
Dr. Munir Ghesani: Many of the newer precision diagnostic radiopharmaceutical drugs have improved the ability of nuclear medicine physicians to diagnose and treat diseases that are particularly prevalent in Medicare patients, such as Alzheimer's disease, prostate cancer, and other cancers. Much of this care takes place in the hospital outpatient setting, where diagnostic radiopharmaceutical drugs are “bundled” into nuclear medicine procedural payments based on averaged costs. Although this bundling process is intended to cover the cost of the diagnostic radiopharmaceutical drug, nuclear medicine staff, imaging equipment, and supplies, in actuality it often does not because of the widely varying costs of the radiopharmaceuticals.

As a result of this practice, hospitals are not receiving adequate payment for the newer precision diagnostic radiopharmaceuticals. Because of the inadequate reimbursement, some hospitals have stopped performing imaging studies using these radiopharmaceuticals, forcing patients to go elsewhere for their testing or to forgo the test altogether.

The FIND Act would require Medicare to adequately reimburse for these lifesaving drugs and procedures by paying for the drugs and procedures separately. By addressing the reimbursement problems, the bill would allow patients of all income levels to have access to these cost-effective diagnostic tools when they need them. Early detection saves lives!

HCB News: Can you describe some specific ways that the current reimbursement rules are compromising patient outcomes?
MG: Because of inadequate reimbursement, some hospitals are not providing nuclear medicine imaging procedures that can precisely and cost-effectively detect conditions such as heart disease, Alzheimer's and Parkinson’s disease, breast and prostate cancer, and neuroendocrine tumors. This limits access to these procedures for Medicare beneficiaries and drives up costs due to ineffective tests and treatments.

HCB News: How do conventional contrast agents used in CT and MR factor into this conversation, if at all?
MG: Conventional contrast agents used in CT and MR do not factor into this conversation as there is a separate reimbursement track for their clinical use. However, CT and MR contrast agents are unable to match precise diagnostic information that can be provided by nuclear medicine techniques using precision-targeted radiopharmaceuticals.

HCB News: What are some of the criticisms opponents of the FIND Act point toward when advocating against it?
MG: Currently, the FIND Act is supported by more than 88 stakeholder organizations, including patient advocacy organizations. No patient group, hospital organization, or industry stakeholders are advocating against it.

HCB News: If enacted, the FIND Act would pertain only to drugs approved by the FDA since 2008 with a mean cost per day of $500 or above. Why those specifications, and what are the main drugs / scans that it would impact?
MG: More than 40 diagnostic radiopharmaceutical drugs are approved by the FDA and currently used for nuclear medicine imaging. Most of these drugs are generic, and for those, “bundling” provides adequate Medicare reimbursement for hospitals; however, bundling does not provide adequate reimbursement for a small subset of precision diagnostic radiopharmaceutical drugs used for narrower and targeted patient populations. These newer drugs provide for a future of more personalized medicine and offer diagnostic advantages over previous generations of diagnostic radiopharmaceutical drugs.

These newer precision diagnostic radiopharmaceutical drugs were FDA-approved after January 1, 2008. Because they are used for narrower and targeted patient populations, they tend to have significantly higher costs. Therefore, these specifications focus the legislative solution on a specific Medicare reimbursement problem impacting Medicare beneficiaries.

HCB News: It's easy to assume improving access to advanced exams and treatments must correlate directly with increasing costs to an already overburdened healthcare system. What do you say to that?
MG: Providing the best diagnostic information available for the patient provides the greatest economic advantage. Medicare is currently paying for therapies, surgery, and hospital stays that would not have been chosen if the most effective diagnostic procedures had been available when needed. In other words, nuclear medicine techniques using precision diagnostic radiopharmaceuticals result in overall cost savings to the healthcare system by avoiding unnecessary and expensive surgeries and expensive therapies in a subset of patients. In fact, there is a strong evidence base to this effect in the literature dating back to late 1990s that was reviewed by the CMS, resulting in the first round of approvals of these techniques in early 2000.

If passed, the FIND Act will ensure that diagnostic nuclear medicine procedures are available to physicians and patients when they are the best and most appropriate choice, eliminating alternative procedures that are less effective. It will improve diagnostic efficiency, reduce costs, and improve patient care and outcomes.