When Congress passed the Deficit Reduction Act (DRA) of 2005, it set in motion legislation that has dramatically affected medical imaging. During the past 18 months of the DRA's implementation, imaging practices have had to come to grips with a new reimbursement landscape that makes balancing the bottom line even more challenging than before.
And the DRA is the least of it, according to Timothy Trysla, executive director of the Access to Medical Imaging Coalition (AMIC) in Washington, DC, (formed by a group of physicians, patients, and providers in 2006 to oppose the DRA) and counsel at Alston & Bird, also in Washington. Trysla spoke at last month's Radiology Business Management Association (RBMA) annual meeting in Las Vegas, warning attendees that more healthcare reform is coming, and it won't be pretty.
"Diagnostic imaging is the fastest growing component of the Medicare Physician Fee Schedule, and every year it's on the forefront for Congress," Trysla said. "Surviving the DRA is not where we're at anymore. Rather, we need to make sure Congress understands the value of the services medical imaging provides, so it's not cut again."
Change the paradigm
Before Congress passed the DRA, diagnostic imaging utilization had shot up dramatically, Trysla said, sparking a huge "blame game," with doctors of different specialties pointing the finger at each other for the trend. The DRA's $13 billion in cuts walloped medical imaging, and there was little organization to oppose it before it passed. Now Congress is in the middle of its annual process of trying to trim money from the Medicare Physician Fee Schedule (MPFS); some of the $8 billion to $12 billion it's cutting this year will most likely come from diagnostic imaging.
In this post-DRA era, it's time to stop the infighting and change the dialogue, according to Trysla: Radiology needs to demonstrate that diagnostic services bring better quality, value, and outcomes for both payors and patients.
"We need a different way of talking about utilization," he said. "To bring more value, more quality to the practice of medicine and change the dynamic of the conversation from a reimbursement issue to a medical issue."
How? AMIC is working to coordinate lobbying, grassroots, and media campaigns, Trysla said, and in 2007, helped introduce bills in both the House and the Senate that would delay further implementation of Medicare cuts for two more years. The coalition also is working to address the Children's Health and Medicare Protection (CHAMP) Act of 2007, which it believes takes the Medicare Payment Advisory Commission's (MedPAC) imaging recommendations too far, negatively affecting seniors and stifling medical imaging innovation. Finally, AMIC plans to introduce and endorse medical imaging appropriateness criteria that is being developed jointly by the American College of Cardiology and the American College of Radiology.
Trysla encouraged meeting attendees to organize and support these kinds of measures, as well as to actively seek out Congressional representatives and their staff and educate them on the real costs of the DRA, including the potential danger for doctors and practices to limit their exposure to Medicare by freezing or reducing acceptance of Medicare patients.
"Go visit your representatives and tell them about how you're struggling to offer services under the DRA," he said. "These cuts are Draconian, but there aren't many people screaming about how it's impacting patient care."
The days of being able to separate the practice of medicine from politics are over, if they ever existed, according to Trysla.
"It may have been possible before to separate politics from reimbursement issues," he said. "But guess what: Now you have to address both."
By Kate Madden Yee
AuntMinnie.com staff writer
June 10, 2008
Related Reading
ACR update: Teaching Congress how to fish, May 7, 2008
Lean principles and ergonomics aid imaging management, April 30, 2008
The best way to run your practice? Look to corporate America, April 3, 2008
Want to survive in a post-DRA world? Start talking, March 4, 2008
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