ARRS speaker: DRA may not be end of imaging payment cuts

May 6, 2007

ORLANDO - The fight to repeal the Deficit Reduction Act (DRA) of 2005 is not over -- and neither is the potential for more payment cuts.

Speaking on the opening day of the 107th annual meeting of the American Roentgen Ray Society (ARRS) in Orlando, Dr. Arl Van Moore Jr., chairman of the Board of Chancellors for the American College of Radiology (ACR), said that "the Congress believes there is still too much fat in imaging, especially in the technical component" of Medicare reimbursements, and lawmakers "likely will still look at imaging to provide additional offsets for other programs going forward. The worst may not be over."

The Reston, VA-based ACR continues as one of the leading radiology associations working for the repeal of DRA cuts for imaging and "to ensure we don't get DRA-ed again," Van Moore said. "DRA has not only become a noun, but also a verb in terms of what people can do to you."

Where's the money?

The biggest challenge is money, and the Democrat-controlled 110th Congress has a multitude of healthcare priorities, not the least of which is continued funding for the State Children's Health Insurance Program (SCHIP). "The funding for this and other initiatives will have to come from some other piece of the pie," Moore added. "If we are going to have any sort of DRA fix, it will likely have to come from imaging."

The ACR and other DRA opponents received some support in March, when U.S. Reps. Carolyn McCarthy (D-NY), Gene Green (D-TX), and Joseph Pitts (R-PA) introduced a bill into the U.S. House (H.R. 1293) that would impose a two-year moratorium on DRA-enacted Medicare reimbursements cuts for imaging. The bill also would instruct the General Accountability Office (GAO) to study the effect the DRA cuts are having on patient access and services, related to the availability and quality of advanced imaging services in physician offices and freestanding clinics.

There are 80 co-sponsors for the House bill. U.S. Sens. Jay Rockefeller (D-WV) and Gordon H. Smith (R-OR) are expected to soon introduce a similar bill into the Senate, perhaps as soon as this month.

SGR dilemma

Another obstacle is the sustainable growth rate (SGR) formula, which determines the Medicare payment for service. A 5% SGR cut for 2007 has been delayed, but the postponement only means the SGR reduction will double, to a 10% reduction in 2008.

"If we keep delaying it, we'll be looking at 50% cuts some time in the next decade," Moore warned. "Clearly, it is a flawed formula, which creates the need for a legislative fix. The problem is, there is a huge dollar sign. In these times of serious budget shortfalls, (Congress) needs to find the money to pay for this moving forward."

There are options to solving the SGR issue, but Moore estimated that a remedy could cost more than $200 billion in the short term. "It is not an easy pill for Congress to swallow," he said.

One option is to scrap SGRs completely, but "that will cost tens of billions of dollars," Moore added, and it will adversely affect radiologists and other practicing physicians. A second proposal would be to implement a Medicare economic index formula, which may be a better way to determine costs, but also will cost money.

"This is a critical time for radiology," Moore told the meeting. "Medical imaging is still the number one target for government savings. Imaging is under attack. Changes in the way physicians are paid by Medicare are on the near-term horizon, and it is coming at a time when the government is trying to realize savings from Medicare.

"The question is," he continued, "can we emerge as the valued experts from medical imaging or will we simply become another commodity? It is up to us."

By Wayne Forrest
AuntMinnie.com staff writer
May 7, 2007

DRA's arrival forces imaging centers to adapt, February 1, 2007

Strategic plan, debt reduction: Proper responses to DRA, January 24, 2007

DRA 2005: The potential impact on the diagnostic imaging market, December 11, 2006

MRI and CT imaging: How fast can reimbursement be cut?, September 20, 2006