Bush veto threat of child insurance bill endangers imaging legislation

Legislation proposing accreditation for most medical imaging modalities has been caught up in a fight between Capitol Hill and the White House over the renewal of federal healthcare insurance subsidies for poor children.

The White House threatened July 26 to veto the Children's Health and Medicare Protection Act, a bill introduced by House Democrats the previous day to extend Medicaid services to an estimated 11 million children. The CHAMP Act would also replace the sustainable growth rate method underlying outpatient Medicare physician payment rate cuts in each of the past three years. It proposes 0.5% rate increases in 2008 and 2009.

Rep. John Dingell (D-MI) introduced CHAMP on July 24. It was scheduled for consideration before the end of the week by the health subcommittees of the Ways and Means and Energy and Commerce committees, chaired by cosponsors Pete Stark (D-CA) and Frank Pallone (D-NY), respectively.

CHAMP provisions aimed at Medicare imaging would eliminate global billing and expand federal accreditation requirements that already apply to mammography to many diagnostic imaging services. If the bill is adopted, MRI, CT, PET, nuclear medicine, x-ray, echocardiography, and emerging technologies would have to be accredited by 2010 to qualify for Medicare payment. The accreditation requirement would apply to diagnostic ultrasound by 2012.

The imaging proposal took a backseat, however, to efforts in the House and Senate to bolster the State Children's Health Insurance Program. That 10-year-old initiative spent $5 billion in federal matching funds in each of the past five years to provide healthcare coverage to 6.6 million children whose families do not qualify for Medicaid and cannot afford private insurance on their own. Without congressional action, SCHIP will expire Sept. 30.

During the week of July 16, the Senate weighed in with a bipartisan effort developed by Senate Finance Committee chair Max Baucus (D-MT) and Sens. Charles Grassley (R-IA) and Orrin Hatch (R-UT). Their compromise plan would increase spending $35 million to expand enrollment over five years.

As with the House bill, President Bush opposed the Senate plan, citing philosophical objections. He threatened a veto and urged senators to consider instead his proposal to increase spending by $5 billion by extending tax dedications that now apply only to employer-based health plans to individuals who buy their own insurance.

The inclusion of imaging-related reforms in the House Democrats' plan reflected an increasing willingness in Congress and the Centers for Medicare and Medicare Services to address diagnostic imaging costs and practices. Numerous provisions that would expand federal self-referral restrictions and more tightly regulate the business practices of independent diagnostic testing facilities were included in the 2008 Medicare Physician Fee Schedule. Also announced in July, the proposed 2008 Hospital Outpatient Prospective Payment System would bundle the technical component of nuclear medicine procedures and the cost of radiopharmaceutical agents.

If enacted, CHAMP would make facility accreditation a nearly ubiquitous feature of outpatient diagnostic imaging and image-guided therapy.

The bill proposes making accreditation similar to the long-standing federal program covering mammography facilities a prerequisite to Medicare payment for outpatient MRI, CT, PET, nuclear medicine, radiography, diagnostic ultrasound, echocardiography, and image-guided procedures. Participation would be required for all modalities except ultrasound by January 2010. Ultrasound services would have until January 2012 to comply.

CHAMP would also discontinue global billing for imaging services. Providers would be required to charge separately for the technical and professional components of imaging furnished beginning about 13 months after the law's enactment.

It modifies the Medicare payment formula for single-session imaging involving contiguous body parts. Under current policy, payment covering the technical component of a second consecutive section is reduced by 25%. Proposed legislation would increase the reduction to 50%.

The bill would also adjust the practice expense formula for reimbursement to assume a 75% utilization of equipment, up from the current 50% presumed rate.

Such attention to medical imaging in a bill mainly aimed at expanding healthcare access to poor children illustrates the political vulnerability of high-tech radiological services, according to attorney Thomas Greeson, a partner in the healthcare groups of Reed Smith LLP in Falls Church, VA.

"It's an indicator that Congress has imaging squarely on its radar," he said.

For more information from the Diagnostic Imaging archives:

Medicare bundling raises concern

CMS gets an earful for reimbursement for coronary CTA

CMS proposes 10% rate cut and self-referral restriction in 2008 Medicare physician payment schedule

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