NRC license fee hikes squeeze nuclear medicine

A recent court decision has given the nuclear medicine communitya forum in which to challenge the Nuclear Regulatory Commission'scontroversial license fees for handling radioisotopes. Nuclearmedicine practitioners charge that NRC fees have skyrocketed bythousands of dollars in the past two years and have caused manynuclear medicine physicians to drop their licenses.

The NRC regulates the medical use of radioisotopes and is requiredby the Omnibus Budget Reconciliation Act of 1990 to recover 100%of its operating costs. As a result, the NRC has hiked the costof its medical licenses by thousands of dollars since the law'spassage.

This year is no exception, with the NRC planning to increasefees to cover rising operating costs. The agency is seeking publiccomment on the proposed fee increases, and many nuclear medicinespecialists have been happy to oblige.

"Their medical licensee increases are obscene," saidDr. Robert J. Lull, head of nuclear medicine at San FranciscoGeneral Hospital. "There is no justification for them goingas high as they have been."

The fees have gone from several hundred dollars a year beforethe Budget Reconciliation Act to up to $45,000 in some cases,according to Kristen D.W. Morris, director of government relationsfor the Society of Nuclear Medicine and American College of NuclearPhysicians.

"That equates to (the cost) of one or two technologists,"Morris said. "These costs cannot be passed on to anyone else."

The increased costs have led many nuclear medicine practitionersto terminate their licenses, according to Morris. Last year theSNM and ACNP counted 400 medical licensees who dropped their licensessince the NRC began operating under the 100% cost recovery rule.

The fees have had an impact in radiation therapy as well asnuclear medicine. Anecdotal reports tell of radiation oncologistsabandoning cobalt radiation therapy devices--which are regulatedby the NRC--in favor of linear accelerators, which are not.

The NRC has allowed fee exemptions for radioisotope users suchas nonprofit educational institutions that cannot pass the increasedfee costs on to customers. This exemption formed the basis fora lawsuit filed by Allied Signal, a nuclear materials companythat charged that the exemption policy was not being applied fairly.

The U.S. Court of Appeals in Washington, DC, agreed with thecompany and in March ordered the NRC to reconsider its policy.The SNM and ACNP are using the momentum from the lawsuit to renewa petition filed last year asking for an exemption to the userfees similar to that granted to educational facilities.

The NRC should give nuclear medicine departments an exemptionfrom the fees because it's difficult to pass increased licensingcosts onto health care consumers, given low reimbursement ratesfor nuclear medicine procedures, according to Morris. The societiesare asking the NRC to freeze its user fee schedule at last year'srates until the petition can be considered.

Few if any hospitals are likely to drop their nuclear medicinedepartments because of the fee increases, Morris said. But risingcosts can erode a department's position within a hospital.

"It makes nuclear medicine more of a loss leader in thehospital," Morris said. "The fee has to be paid forout of some existing budget. It could affect equipment purchasing,hiring or radiopharmaceutical budgets."

The period for public comment on the Allied Signal case hasexpired, but the NRC is accepting comments on the proposed feeschedule until July 19. Comments should be addressed to the Secretaryof the Commission, Nuclear Regulatory Commission, Washington,DC 20555, Attention: Docketing and Service Branch.