NEMA steps into MRI accreditation flap as Aetna’s compliance deadline looms

Many sites could lose reimbursement for MRI scans

The Y2K problem could have special meaning for MRI operators in the U.S., unless efforts by the National Electrical Manufacturers Association (NEMA) succeed. The Rosslyn, VA, industry association is trying to avert a market meltdown that could occur at the beginning of next year if one of the nation’s largest insurers refuses to reimburse for MRI scans done at imaging centers that aren’t accredited. NEMA believes the policy could have major economic ramifications for MRI services providers and manufacturers if it is not revised.

MRI center accreditation has been a controversial topic since the idea was first suggested by the American College of Radiology in the early 1990s (SCAN 1/8/97). Proponents believe that site accreditation can be a valuable instrument for improving the quality of MRI services, in the same way that mammography accreditation has improved patient care in that modality. Some vendors and imaging centers, however, are concerned about how the ACR has implemented site accreditation, and in particular the high failure rate of MRI centers applying for accreditation.

The stakes in the conflict were raised late last year, when Aetna U.S. Healthcare announced that as of Jan. 1, 2000, it will require imaging centers submitting reimbursement requests to be accredited under the ACR program. Aetna wields considerable power in the imaging services market: In 1998, the company reimbursed providers for nearly 100,000 MRI procedures.

NEMA decided to enter the controversy because of its concerns about the impact the Aetna policy could have on both imaging providers and the manufacturers of equipment. On June 11, the group’s Diagnostic Imaging and Therapy Systems arm sent a letter to Dr. Arthur Leibowitz, chief medical officer of Aetna, asking that the managed-care group back off its accreditation policy.

“In the letter, we point out that less than 4% of the installed base has been accredited,” said Dave Snavely, industrial manager of the MRI section at NEMA

The task of protecting practitioners has fallen to NEMA rather than the ACR because some market watchers believe that the college is part of the problem rather than of the solution. The failure rate of first-time applicants for MRI accreditation has been steadily creeping upward, reaching 50% in early June 1999, compared with 47% last October, according to the ACR. As of early June, 935 facilities had applied for accreditation of 1122 units. Only 216 facilities had succeeded, despite the more than two years that the accreditation program had been in operation.

Trying to help?Actions taken by the college about six months ago have had no apparent effect on the number of sites failing accreditation. At that time, the ACR implicitly acknowledged that the high failure rate of MRI centers was a problem. To help alleviate the situation, the ACR began allowing sites to purchase the phantom used in the accreditation process, and in November it published a 33-page monograph that advises applicants on how the phantom is used in the examination.

These measures are helping the situation, according to an ACR official who requested anonymity. While the failure rate for first-time applicants continues to be high, the rate drops to 20% when failed applicants resubmit for accreditation, the ACR official said.

“People are making changes to improve quality, and that is why the pass rate goes up on the second attempt,” he said. “It is meant to be an educational program and we believe it is working this way.”

But NEMA alleges that the ACR is not helping as much as it could. The manual and phantom are useful, but the college is not willing to provide phantom specifications to manufacturers, according to Snavely.

“We have to try to figure (the specifications) out for ourselves,” he said.

Operators of open MRI systems are particularly disadvantaged by the accreditation process, because the ACR test may have been designed for closed rather than open MRI systems, according to Robert Britain, NEMA vice president of medical products.

“I think the criteria need to be examined for lower tesla systems,” he said.

Another possible solution to the high failure rate is the entry of one or more groups other than the ACR to perform accreditation. The Intersocietal Accreditation Commission (IEC) is one such candidate. The Columbia, MD, organization currently accredits vascular laboratories, as well as echocardiography and nuclear medicine sites. Sources within the commission indicate that the IEC has not yet decided whether to launch an MRI program. Among the issues that need to be worked out is how to handle a conflict between two accrediting organizations if one passes a site and the other fails it.

Caught in the middle are MRI facilities that have yet to be accredited by the ACR program. In its letter to Aetna, NEMA noted that the U.S. has an installed base of about 5000 MRI scanners, but barely 200 have been accredited. Many of the unaccredited sites have a lot to lose after the first of next year.

While NEMA and its vendor members are concerned for MRI sites and associated radiologists, they are also concerned for themselves. With the MRI industry coming off the best sales year in its history, corporate executives do not want potential customers to have second thoughts about buying new systems in 1999.

“Reimbursement affects us,” Snavely said. “If facilities can’t get reimbursed, they are no longer going to be purchasing equipment.”