The Obama administration has released its 2015 budget plan, which largely reflects proposals that were included in the 2014 budget and will most likely not affect medical imaging -- for better or for worse, according to the American College of Radiology (ACR).
"The likelihood of this budget going anywhere is nil," Cynthia Moran, ACR's assistant executive director for government relations, told AuntMinnie.com. "It's a political document that sets out, in broad terms, the White House's policy priorities. It will be used more for campaign purposes in the upcoming midterm elections, since it leans heavily left to shore up the candidacies of the progressive side of the party."
The budget does address two areas of concern for medical imaging: prior authorization and the exclusion of certain services from the Stark law's in-office ancillary services exception.
The U.S. Centers for Medicare and Medicaid Services has authority to require prior authorization for Medicare durable medical equipment service items. This budget would extend that authority to all Medicare fee-for-service items, particularly those at the highest risk for improper payment -- as well as in two service areas: power mobility devices and advanced imaging -- for an estimated savings of $90 million over 10 years.
"The fact that diagnostic imaging services are lumped together with scooters underscores how ridiculous this proposal is," Moran said.
As for in-office ancillary services, the budget proposal would amend the in-office ancillary services exception (IOASE) to prohibit certain referrals for radiation therapy, therapy services, advanced imaging, and anatomic pathology services, for an estimated savings of $6 billion over 10 years, ACR said.
"Most of the Medicare proposals in this budget would require legislation to implement, and in this political environment anything controversial -- like self-referral reform -- won't be considered on the hill," Moran told AuntMinnie.com.
The document also lauds bipartisan sustainable growth rate (SGR) reform efforts in Congress and proposes strengthening the Independent Payment Advisory Board, a 15-member panel established as part of the Patient Protection and Affordable Care Act that can make changes to Medicare programs without the approval of Congress, according to ACR.
Mixed reactions
Professional groups' reactions to the budget proposal were mixed.
The Medical Imaging and Technology Alliance (MITA) said in a statement that the budget would threaten patient access to imaging services and hinder innovation by instituting the prior authorization system.
"The president's budget directly counteracts the administration's efforts to reduce healthcare costs and encourage advanced manufacturing in communities across our country by instituting a burdensome prior authorization system," said MITA Executive Director Gail Rodriguez. "Inserting a bureaucratic middleman between physicians and patients will limit seniors' access to diagnostic services, while resulting in wasteful healthcare spending and fewer investments in research and development."
Other professional groups such as the Large Urology Group Practice Association (LUGPA) criticized the budget's self-referral language.
"Excluding certain services from the IOASE will not have any meaningful impact on utilization or cost reduction and will only jeopardize patient access to comprehensive, cost-effective treatment at the healthcare site of their own choosing," said Dr. Deepak Kapoor, LUGPA's chairman of health policy.
But the Alliance for Integrity in Medicare (AIM) -- a coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral -- praised the budget's self-referral language.
"AIM has long supported additional limitations on physician self-referral, and we applaud the administration for including IOASE reform for a second year, and also for adding anatomic pathology services to the proposed list of excluded services," the organization said.
