In the past week U.S. lawmakers have delivered two bills to the House of Representatives aimed at raising Medicare payments for screening mammography. While both are based on Senate Bill 548 introduced last month by Sen. Tom Harkin (D-IA) and Sen. Olympia Snowe (R-ME), the House bills differ in the scope of their solutions.
On April 3, Rep. Peter King (R-NY) and Rep. Anthony Weiner (R-NY) introduced H.R. 1354, the Assure Access to Mammography Act of 2001. And on March 30 Rep. David Hobson (R-OH) introduced the Medicare Mammogram Access Protection Act of 2001 as H.R. 1328.
The bills start off pretty much the same. Like Harkin's Senate bill, both would raise the global Medicare reimbursement rate for screening mammography from an average of $68 to about $90.
The bills would also delay transfer of the power to set screening reimbursement rates from Congress to a commission known as the Relative Value Update Committee (RVUC) for one year, until January 1, 2003. Mammography advocates have expressed concern that the RVUC would set rates too low to cover the cost of complying with the Mammography Quality Standards Act.
Finally, both bills would commission a Medicare Payment Advisory Committee (MedPAC) to examine the appropriateness of Medicare payment levels for all mammography screening services.
But the Hobson bill stops there. It doesn't include graduate medical education (GME) funding that would pay for three additional radiology residents at each teaching hospital, or commission a separate study on gender-specific Medicare services, as both of the other bills do.
King's legislative assistant, Kerry Ann Watson, said her boss' legislation does all that and more.
"We are the exact Harkin companion bill, with the exception that we expand the GAO [General Accounting Office] study to look at institutional reimbursement such as in hospitals and skilled nursing facilities, as well as reimbursements to physicians," Watson said. "There's a general concern among healthcare providers, and [in] Congress as well, that we really need to pay close attention to reimbursements that are being given to institutions such as skilled nursing facilities and hospitals, to make sure [they] are at least within the league of compatibility to costs. We know that they are far below where they should be."
Implementing Hobson's version would be slightly cheaper, according to Watson, but the GAO study won't be a huge expense in the King bill. Moreover, the bill's GME provisions are absolutely essential for addressing staff shortages in mammography services, Watson said.
A representative from Hobson's office said the Ohio representative's bill is narrowly focused on reimbursement because that is the most important concern of the many radiologists the representative has communicated with on the issue.
"I don't think we're opposed to [GME]; I think we wanted to look into it further," said Michael Beer, healthcare assistant to Hobson. "I don't think we had enough information to be sure it was the right step.... People told us the biggest problem is the reimbursement rate."
What's important is that everyone work together to find the best solution, he said.
"I told King's office, and I told other people who are interested in this, that in no way, form, or fashion are we looking to work at cross-purposes," Beer said. "I think we're interested in this issue together, and if [GME] gets us moving toward the right solution, we're fine with that."
Finally, there's an issue that none of the mammography bills addresses because it's politically impossible, Beer said.
"One of the things we hear is driving the costs up is the threat of a lawsuit," and the cost of liability insurance, he said. "I think the gold standard for film mammography is 85% reliability. Well, the 15% they don't catch are coming back and suing. I'm not sure what the way to get at that is. Nobody wants to limit justice for victims of breast cancer, but I think it's an issue that's driving people out of the business."
By Eric Barnes
AuntMinnie.com staff writer
April 6, 2001
Related Reading
U.S. senators introduce bill to raise screening mammography payments 30%, March 19, 2001
Changes in Medicare reimbursement for screening mammograms, February 23, 2001
Harkin will introduce bill to raise screening mammography payments, February 6, 2001
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