Q&A: What Are Radiologists Doing on Capitol Hill?

Every year, the American College of Radiology (ACR) hosts Hill Day – a day when industry leaders descend upon Capitol Hill in Washington, DC, to lobby members of Congress on issues of importance to practitioners and the radiology field as a whole. This year, the number of grassroots radiologists who attended and spoke to federal legislators more than doubled. Diagnostic Imaging discussed this year’s Hill Day with Andrew Wu, MD, chair of the ACR Radiology Advocacy Network.

According to Wu, ACR representatives discussed a single facet – transparency – around two key topics – breast cancer screening and the Multiple Procedure Payment Reduction – with legislators.

Why does the ACR have this event?

As long as I can remember, and I’ve gone for 12 years, we’ve always gone up to Capitol Hill during our annual meeting. The ACR has Hill Day because advocacy is a core value of the College. As such, advocacy has always been promoted. This is why Hill Day is always part of the annual meeting.

What issues were discussed?

We thanked our legislators for[[{"type":"media","view_mode":"media_crop","fid":"38737","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4508158020804","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3878","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Andrew Wu, MD","typeof":"foaf:Image"}}]] supporting the Sustainable Growth Rate (SGR) fix and thanked them for their support with our efforts around lung cancer screening. There are two issues that we brought up this year, though. One is the US Preventive Services Task Force review of screening mammography. The agency was formed to really help give recommendations to primary care. Through the Affordable Care Act, it was given great governance and input into reimbursement issues for screening procedures. They give letter grades for various types of procedures. Anything from a B rating and up means private insurers and Medicare will cover them. For example, lung cancer screening was given a B score.

For the ACR, the American Cancer Society, and the American College of Obstetrics and Gynecology, the recommendation for screening mammography has been for women age 40 and up. The task force gave that a C rating. Breast cancer screening is controversial. The opinions are everywhere, and screening women ages 40 to 49 received that C rating. The implication is that private insurers won’t necessarily have to cover it. Medicare may not cover it. That means 16 million to 17 million women in the country might not get screened. In my practice, that age group accounts for 25% of screenings. It’s a tremendous number of women who, because of financial concerns and confusion about appropriateness recommendations – may or may not have a screening study.

The problem is that there is no transparency in the process. There’s no transparency in how this task force came to this decision. No stakeholders in breast imaging were really involved in the decision. That’s a shame. There were many epidemiologists and primary care physicians, but if you make a decision impacting so many women, you need to have breast cancer specialists included. They could be from surgery, oncology, or radiology, but you need to have them involved.

We’ve asked our legislators to encourage the head of the Centers for Medicare & Medicaid (CMS) to basically reconsider the rating and for Medicare to mandate that breast screenings for this age group be covered. We want transparency in this process. As a government agency that has so much input into reimbursement issues, Medicare needs to be a partner in this process.

The second aspect we discussed was the Multiple Procedure Payment Reduction. Last year in the SGR patch, there was a provision that mandated the release of the data supporting the 25% professional component reduction after hitting the technical component side. It devalues what we do. My analogy is when you pay for a book, you read every page. We have complicated, sick patients with cancer and trauma – we have very ill patients that have multiples studies done on them, and, in a sense, we’re not being reimbursed for reading every page. What the ACR has done through its research institute is review the studies that show efficiencies are nowhere near the 25% reduction that they’ve mandated. It’s more like the 3% to 5% range. That’s a big difference. In this SGR patch, there was a provision put into the legislation that mandated the release of that data on MPPR. That was over a year ago. There is legislation that was proposed in the 21^st Century Cures Act, but at the time of our original discussion, this topic wasn’t included. That really speaks to the need for transparency with CMS.

All we want with both issues is transparency. It’s not that we’re not willing to work with legislators. If you go back to the SGR patch, we’re doing things that are the best things for the patients in our communities, such as using clinical decision support. We’re trying to do the right things, but we need to make sure that it’s done with data and transparency.

What was the response to your efforts?

We were received very well. They understand the issue of transparency, and a legislator in North Carolina signed onto the breast cancer screening bill as a co-sponsor that night. He felt very strongly about it, and his reference point was prostate cancer. When it came to prostate cancer, he didn’t know what the right thing was, so he understood our plight.

What is the benefit of Hill Day?

The benefit of Hill Day is to give members of the ACR the opportunity to personally advocate for issues that plague our profession. We did have an exceptional turnout of 650 radiologists visiting 300 congressional offices. With successful Hill Days and with the Radiology Advocacy Network, we want to continue to strengthen the ACR’s advocacy efforts.