The Medicare Payment Advisory Commission (MedPAC) is recommending the adoption of standards that would limit who can provide imaging under the U.S. federal health plan.
The 16-member commission voted unanimously in favor of six suggested actions on imaging at a January 12 public meeting in Washington, DC. MedPAC will formally present the imaging proposals, along with a slew of other recommendations, in a March report to Congress.
Two of the recommendations adopted by MedPAC are akin to the designated physician imager (DPI) concept being developed and promoted by the American College of Radiology (ACR) in Reston, VA.
Specifically, MedPAC recommended that "the Congress should direct the Secretary (of Health and Human Services) to set standards for all providers who bill Medicare for performing diagnostic imaging services," and "for physicians who bill Medicare for interpreting diagnostic imaging studies."
While MedPAC's endorsement is no guarantee of congressional action, the commission's vote is considered an important boost.
"It's certainly significant in that MedPAC is set up as an independent advisory body to Congress," said Joshua Cooper, the ACR's director of congressional relations.
"Historically, MedPAC recommendations are considered very seriously by the jurisdictional committees," noted Cooper, referring to the legislative entities that have first dibs on Medicare policy -- Ways and Means Committee and the Labor, Commerce and Industry Committee in the House of Representatives, and the Finance Committee in the Senate.
But the recommendations will likely continue to face opposition from an array of medical specialty societies that have organized themselves as Physicians for Patient-Centered Imaging (PPCI). The group has already been active in opposing the MedPAC proposals in letters and statements before the commission.
More than 25 groups are part of the PPCI coalition, including the American Medical Association, American Academy of Neurology, American Association of Orthopaedic Surgeons, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, American College of Surgeons, Society for Cardiovascular Magnetic Resonance, and the Medical Group Management Association.
Cooper said he hopes that some of the opposition the ACR's designated physician imager concept will dissipate over time.
"I think a lot of folks are still concentrating on what everyone first believed was going to be our policy -- to close the in-office ancillary loophole (in the Stark law on imaging center referral and investment). We no longer believe that is necessarily the best policy," Cooper said.
Instead, a DPI approach could involve standards achievable by radiologists or nonradiologists, although Cooper acknowledged that reducing the volume of self-referred imaging would be key to achieving the cost savings the ACR is touting.
"Some who may be 'in the game,' so to speak, to get more income may feel that the standards might be too much for them," Cooper said. "They in essence would stop and that's where you would see some of the savings."
While implementing standards is old hat to hospitals and insurers that do privileging, and to entities that provide accreditation, some MedPAC commissioners expressed concerns about the challenges for a federal agency.
"It is putting Medicare into a situation they've never been before, and it is not at all clear to me how they will, in fact, deal with this," said commission member Sheila Burke.
The commission opted to leave specific suggestions on what the standards might cover out of its official recommendations and address those only in the text of its report to Congress.
Also among MedPAC's recommendations was the proposed inclusion of nuclear medicine and PET procedures in the Stark law, named for its author Rep. Fortney "Pete" Stark and formally known as the Ethics in Patient Referrals Act.
Cooper said the ACR has long been pushing for the inclusion of those modalities under Stark, calling their omission from earlier law an "oversight" that needed correction.
MedPAC's proposal would preclude physicians from investing in nuclear medicine or PET centers where they refer patients, but would not alter the law's in-office imaging exception.
The commission also recommended that "physician ownership" under the Stark law include "interest in an entity that derives a substantial proportion of its revenue from a provider of designated health services" -- a proposal intended to close a loophole allowing physicians to invest in companies that lease equipment to providers.
In its remaining proposals on imaging, MedPAC recommended that the Centers for Medicare & Medicaid Services (CMS) begin to measure physicians' use of imaging services "to encourage more appropriate use." MedPAC also said CMS should "improve Medicare's coding edits that detect unbundled diagnostic imaging services and reduce the technical component payment for multiple imaging services performed on contiguous body parts."
By Tracie L. Thompson
AuntMinnie.com staff writer
January 18, 2005
Related Reading
ACR to pitch Congress on 'designated physician imagers' for Medicare, January 6, 2005
Nation's largest insurer to adopt ACR criteria, accreditation, December 9, 2004
Radiologists (mostly) cheer as insurers set imaging rules, November 4, 2004
Stark II interim final rule leaves huge self-referral loophole, July 20, 2004
Radiology’s reimbursement future hinges on good data, October 23, 2002
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