AHRA 2011: Debt-weary Feds Eyeing Imaging Cuts

GRAPEVINE, TX - Now is the time to speak up.

That's the message from Maggie Sayre, executive director of the Association for Quality Imaging in Washington, D.C.

Everyone from radiologists to technologists must address upcoming health care changes, as the imaging industry reels from - and faces probable new - cuts in federal funding, she said. "Things are changing very rapidly in D.C. right now," Sayre warned AHRA conference attendees this week. "We need to be very vocal."

The imaging industry has suffered through about $8 billion in losses brought about since the Deficit Reduction Act passed in 2005, Sayre noted. The federal government's latest attempts to tackle the country's debt crisis threaten even more.

As congressional leaders sit down to try cutting $2 trillion in debt by this winter, nothing is sacred.

"Diagnostic imaging is absolutely on the table," she said.

The threat is compounded even more for an industry like imaging, which Sayre said not only isn't as politically entrenched as other public interests, but also has an image problem on the Hill. "They think we're over-utilized, over-utilized, over-utilized," she said. "They view us as a very fat industry."

And Congress is attempting to cut that perceived fat with unfamiliar butchers. Further complicating the process, Sayre said, is the fact that negotiations are taking place among Beltway insiders, but not of the imaging world.

Staffers who may be more accustomed to haggling over dollars and cents, not CTs, are proposing often arbitrary changes to industry standards and policies on things coding and reimbursement rates. Sometimes, proposed rule changes affecting the imaging industry have come without public comment.

"It's a little bit scary," Sayre said.

The haste with which some of the significant changes also has given Sayre a fright. Bundling the abdomen and pelvis CT codes already has cost the industry millions, as some in Washington want to push through a proposed rule combining 10 more.

Sayre said AQI is pushing for an open, thoughtful process, one supported not by haste, but by scientific research. She countered the hopes of some other groups, including MedPAC, to quicken the combos.

"It's absolutely a process that should not be fast tracked," she cautioned.

Radiologists and industry watchers should be aware, too, Sayre said, of attempts to spike utilization levels, built into formulas setting reimbursement rates. The higher the utilization rate, the lower the reimbursement for health professionals.

And what was once considered a dirty word hushed behind closed doors, is now finding itself in many health care cost discussions: self referral. While historically, self referral has been a "very difficult, politically charged issue," Sayre said, more and more legislators are weighing the cost-savings benefits of the practice.

A study on the effects of self referral by the U.S. Government Accountability Office is expected to be wrapped this fall. The outcome of that and other research will likely play pivotal roles in how congressional leaders choose to wield the sythe when it comes to diagnostic imaging.

Sayre encouraged AHRA members to vocalize their concerns about imaging resources on the chopping block during debt talks this winter, and the near future. "You need to absorb what's happening to us,” she said. “And communicate to your legislators."