The U.S. House of Representatives has released a draft version of new health reform legislation. One section has already garnered much controversy--the payment for medical imaging. In the legislation, there is an adjustment in practice expense to reflect higher presumed utilization of imaging equipment--75 percent (rather than the current 50 percent).

The effect of these changes is a concern for industry advocacy groups such as the Association for Quality Imaging (AQI), which is urging Congress to reject the change. AQI points out the research from the Radiology Business Management Association (RBMA) that says rural practitioners have a lower utilization rate, and that the utilization rate of practitioners is lower overall than that which the Medicare Payment Advisory Commission (MedPAC) recommended for Medicare reimbursement (as reported in DM 9421).

AQI has stated on its website that the MedPAC assumptions do not include all imaging modalities (such as PET/nuclear medicine) and the analysis did not include the harsher impact to rural practitioners. AQI also stresses that the MedPAC methodology does not consider a patient's age or health, which can significantly impact patient preparation time and, the AQI says, is the most important factor in the length of an imaging appointment and therefore utilization rates. The older and less healthy the patient, the longer preparation and examination time required, highly pertinent to the Medicare population.
The AQI reports that eight Senators have signed on to a bipartisan letter written by Senator Herb Kohl (D-WI) and Senator Orrin Hatch (R-UT) to
Charles Grassley, Senate Committee on Finance chairman, that opposes an increase in the utilization assumption for advanced imaging equipment. The eight Senators are Robert Bennett (R-UT), Jim Bunning (R-KY), Susan Collins (R-ME), Mike Crapo (R-ID), Christopher Dodd (D-CT), Kirsten Gillibrand (D-NY), Tim Johnson (D-SD), and David Vitter (R-LA).

Fifty-seven Congresspersons have already signed a similar letter to the President (as reported in DM 9407). The letter from Senators Kohl and
Hatch says that the proposed change to the assumption would "further reduce medical imaging reimbursement on top of the billions of dollars cut by the Deficit Reduction Act of 2005 (DRA). We believe that both of these proposals could restrict Medicare beneficiaries' access to life-saving imaging services."

The American College of Radiology also feels that the MedPAC data does not reflect the true amount of time a practice operates its equipment and that this new normative standard will harm legitimate providers. As example, the ACR says radiologists that provide imaging services to community hospitals would find it impossible to reach the utilization rate recommended.

The Access to Medical Imaging Coalition (AMIC) also strongly urges reconsideration of the changes, citing the RMBA data.

The legislation may be accessed at:
http://www.aqimaging.org/pdf/House/hrdraft_xml.pdf

Based on press releases and statements by AQI, ACR, AMIC.

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