Bill in US Senate threatens medical imaging

Anne L. Fischer, anne.fischer@laurin.com

Tracking the US health care bill and how it will affect the imaging industry is like trying to shoot at a moving target. Senate Majority Leader Harry Reid’s bill, currently being debated in the Senate, has changes in the physician fee structure and reimbursement that will not be good news for the imaging industry. However, several members of the House and Senate may introduce legislation to eliminate physician pay cuts that also reduce imaging reimbursement.

The market for medical imaging equipment, driven largely by reimbursements that manufacturers receive from those who use the equipment in patient care, is threatened by the health care bills currently under consideration. Although Medicare provides only a part of the reimbursement for these procedures, the overwhelming majority of payments made nationwide is based either directly on Medicare or on a Medicare methodology. Therefore, a decrease in Medicare reimbursement means that providers are less willing to purchase new equipment.

What we do know, however, is that the Reid bill calls for significant cuts in Medicare reimbursement for medical imaging. Dr. John Boyes, a radiologist in Bow, Wash., and a board member of the Radiology Business Management Association, believes that the Senate will “probably pass some kind of health legislation, but it will probably be different from the House bill.” He said the legislation likely will go before a House/Senate committee to reconcile the differences, after which it will have to go back to the House and Senate for final approval.

President Obama has threatened to veto any legislation that renders health care reform nonreimbursement-neutral; that is, anything that does not reduce costs. Boyes questions whether the president actually will veto cancellation of the expected reduction in physician compensation. “My best guess is he will fold and not veto anything.”

Depending on how these factors play out, the reduction in reimbursement for the technical component of CT and MRI easily could exceed 30 percent, Boyes said. “Regardless of the final results, we think a significant cut [especially for CT and MRI] is on the way.”

Besides affecting the imaging industry, patient care may be jeopardized. Twenty patient advocate groups wrote to Obama and to Health and Human Services Secretary Kathleen G. Sebelius to oppose cuts to Medicare reimbursement for diagnostic imaging, stating that reduced imaging would “jeopardize the health of America’s seniors by delaying or precluding their access to the front-line tools that turn early detection into effective treatment and patients into survivors.”

New cancer rates in the US are projected to increase by 45 percent over the next 20 years, mostly among the elderly and minority populations, according to a study published April, 29, 2009, in the Journal of Clinical Oncology. Screening for cancer, such as mammograms, already was reduced by the Deficit Reduction Act of 2005. And according to a study conducted by Moran Co. of Rosslyn, Va., screening fell nearly 30 percent from 2006 to 2007.

The current legislation being considered is not entirely clear, Boyes said. One piece of the final ruling states that the utilization fees will apply only to equipment that costs more than $1 million, while in another area, it places limits on CT and MRI scans only.

“The whole business is complicated,” Boyes noted. “If the cuts are left in, the economic viability of imaging centers will be at risk.”