Chapter Leaders Meet in Chicago
ACR leadership called a meeting in late February to review and discuss the College's federal legislative and regulatory efforts regarding reducing inappropriate utilization of imaging. Chapter leaders from 41 states, Puerto Rico, and the District of Columbia met in Chicago to discuss the latest developments about economically driven self-referral and increased utilization of imaging services by nonradiologists, and strategies to address it. As chapter representatives and councilors would be discussing this issue during the Congressional Visit Day during the ACR Annual Meeting and Chapter Leadership Conference (AMCLC), Board of Chancellors Chair James P. Borgstede, MD, wanted to give leaders ample opportunity to discuss the topic.
Borgstede led the presentation to update chapter leaders on the ACR's yearlong initiative to develop an effective federal legislative policy to reduce inappropriate imaging utilization. Additional presentations were made by ACR Executive Director Harvey L. Neiman, MD, Assistant Executive Director of Government Relations and Economics Cynthia Moran, Senior Director of Government Relations Josh Cooper, Director of Economics and Health Policy Rachel Kramer, State Legislative Specialist for Political Outreach and Development Ariel González, and health policy consultant Don Moran of The Moran Company.
The panel discussed the ACR's efforts to educate lawmakers and regulators about the problem and the cost associated with imaging overutilization, and its assessment of the most prudent course of action to be taken at the federal legislative level. They explained the initial legislative goal was to convince policy makers to close the in-office ancillary loophole contained in the current Stark II laws, which would restrict physicians' ability to self-refer diagnostic imaging services. While this goal is highly supported by the radiology profession, it is strongly opposed by most other physician specialties and not supported by the Republican majority in Congress.
ACR leaders then began to explore a policy that would tie Medicare reimbursement for medical imaging services to providers meeting certain quality, safety, education, and training standards: a Designated Provider of Medical Imaging or DPMI. Only those physicians and facilities meeting these standards could be reimbursed under Medicare. This policy closely parallels recommendations recently published by the Medicare Payment Advisory Commission (MedPAC), a respected independent group that advises Congress on Medicare payment issues. In addition to substantially raising the quality and safety standards associated with medical imaging, ACR consultants have calculated this approach would generate savings to Medicare of $4-6 billion over 10 years.
Although the DPMI policy would ask the Secretary of Health and Human Services to establish standards similar to the ACR's current voluntary standards for MRI, CT, and PET, MedPAC's recommendations are broader and would ask the secretary to establish standards for all imaging modalities.
Borgstede emphasized that in the absence of amending Stark II, DPMI was the only viable strategy that could reduce the overutilization of medical imaging. He further stated this policy had the strong initial support of legislators and regulators who had met with the ACR. The only other option was to do nothing, which could lead possibly to across the board cuts for all imaging services, competitive bidding, or a separate RBRVS for imaging services. Borgstede also made it clear that pursuing this policy did not mean the College was abandoning its vehement stance against self-referral, and encouraged all chapter leaders to work at the state and local levels to explore other potential avenues to reduce self-referral.
Following the presentations, chapter leaders were asked to share their views on the DPMI policy as well as their thoughts regarding a resolution asking for the ACR Council's support. Meeting participants indicated broad support for pursuing the DPMI policy. The resolution was to be presented at the ACR AMCLC in April (pending as of press time; look for updates on the ACR Web site, and in future issues of the ACR Advocate and the ACR Bulletin).
For more information on the DPMI policy, please contact Joshua Cooper, ACR Senior Director of Government Relations, at joshuac@acr.org or at (800) 227-5463, ext 4308.