Federal imaging proposals mesh with ACR initiatives

RADPAC, the American College of Radiology's political fundraising arm, rated among the top five health industry political action committees in terms of financial contributions last year, having bestowed nearly $1 million in the last election cycle. If this is any indication of the ACR's pull on Capitol Hill, the landscape for diagnostic imaging could look vastly different as Congress debates controversial proposals aimed at curbing the rising cost of imaging.

The Medicare Payment Advisory Commission (MedPAC) will present a report to Congress this month with six recommendations, including two that will set national quality standards for performing and interpreting outpatient diagnostic imaging covered by Medicare. These recommendations are similar to the ACR's designated physician imager (DPI) concept. Earlier this year, the college tagged the DPI as its top legislative priority for 2005.

"The MedPAC recommendations endorse our approach to the solution to this problem," said Dr. James Borgstede, chair of the ACR board of chancellors.

ACR data show that legislation or regulation discouraging inappropriate utilization could save Medicare a minimum of $3 billion to $8 billion over 10 years, he said.

Commission member Sheila Burke sounded a note of caution during a public hearing, although she fully supports the recommendations. She said that Medicare might suddenly take over responsibilities previously handled by licensing boards and specialty societies. Burke said she didn't recall any other instance in which Medicare established by regulation specific requirements for physicians who are qualified to bill for certain kinds of activities. The Mammography Quality Standards Act, however, does authorize the FDA to enforce minimum educational and reading volume standards for physicians who interpret mammography.

The 16-member MedPAC panel recommended closing a loophole in Stark II regulations that allows physicians to invest in leasing equipment in imaging centers to which they refer patients. It also proposed extending the self-referral restrictions to freestanding nuclear medicine and PET services. The commission fell short of recommending a ban against office-based self-referral, a practice critics say is a major contributor to the 14% annual increase in Medicare outpatient imaging costs for the past two years.

The report seeks a mechanism to monitor imaging utilization, particularly of CT and MR. Physicians would be benchmarked and advised confidentially when overutilization is suspected. Improvements to Medicare's coding edits were recommended to detect unbundling and other practices that exploit coding weaknesses to inflate charges.

"Whether or not these changes are adopted by Congress, it is clear that containing utilization of diagnostic imaging is important to policymakers," said Thomas Greeson, a healthcare lawyer with Reed Smith in Falls Church, VA, and a Diagnostic Imaging columnist.

The proposals that relate to Stark II regulations can probably achieve political success easier than the others, Greeson said.

The ACR is currently working with members of Congress to seek sponsors for the recommendations. Congress could debate the issue as early as the fall.

The college can expect opposition from members of other medical societies, such as the American College of Cardiology, who use imaging in their practices. But these changes go beyond turf issues, Borgstede said.

"If radiology were approaching this as a turf battle, we'd want all the imaging to come to us. But we're saying there is inappropriate utilization, and we have a solution, and our solution is in line with the MedPAC recommendations," he said.