Years of advocacy effort on behalf of radiologists, radiation oncologists and other physicians were rewarded in 2015 with Congressional passage and adoption of the Medicare Access and CHIP Reauthorization Act (MARCA) and the Consolidated Appropriations Act.
Sustainable Growth Rate (SGR) Repeal
The passage of MARCA in April 2015 marked the end of the Sustainable Growth Rate (SGR), a flawed Medicare cost-containment policy that forced Congress to enact so-called patches year after year to delay ever-increasing physician reimbursement rate cuts. MARCA also extended the Children’s Health Insurance Program (CHIP) for two years, instituted a 0.5 percent increase in Medicare physician reimbursement over the next four and a half years, established a new Merit-Based Incentive Payment System (MIPS) for Medicare and provided innovative options for physicians to transition to alternative payment models (APMs).
When fully implemented, the MIPS program will align CMS’s three existing clinical quality assurance programs, specifically the Electronic Health Record (EHR) “meaningful use” policy, the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBM) and newly created clinical improvement activities into a single, modified fee-for-service program. The legislation also provides a five-year period of bonus payments for physicians who choose to participate in APMs that include two-sided financial risk.
Although passage of MARCA was an incredible legislative achievement, monitoring the implementation of these new programs and their effect on radiology will be an ongoing process lasting several years.
Consolidated Appropriations Act
While pleased with the success of its active role in supporting MARCA legislation, the American College of Radiology (ACR) continued to seek opportunities to achieve its other major legislative priorities in the latter half of 2015. Its government relations staff sought a legislative remedy for Medicare’s questionable multiple procedure payment reduction (MPPR) discount for the professional component for advanced diagnostic imaging, and it lobbied for a Congressional order requiring the U.S. Preventive Services Task Force (USPSTF) to delay implementation of its controversial screening mammography recommendations.
Legislative opportunities to address both issues arose in the form of the annual Congressional year-end “Omnibus” appropriations package. After intense negotiations, the College saw legislative language for both priorities added to the Consolidated Appropriations Act (CSA). The legislation was passed by Congress and signed into law by President Barack Obama December 18.
With CSA enactment, Medicare’s current 25 percent MPPR discount for interpretation of advanced imaging scans performed on the same patient in the same session and on the same day was rolled back to a 5 percent reduction. The 5 percent discount reflects research conducted in 2012 that suggests the interpretative efficiencies for scans from multiple body parts range from 3 percent to 5 percent depending upon the imaging modality. The MPPR rollback will become effective January 1, 2017.
The ACR also successfully advocated for inclusion of legislative language delaying implementation of USPSTF draft breast cancer screening recommendations for two years.
This provision, which borrowed heavily from the Protect Access to Lifesaving Screening (PALS) Act, means millions of American women will continue to receive screening mammography as a covered insurance benefit that could have been lost if the USPSTF guidelines were implemented. The ACR believes its support of annual screening mammography for women beginning at age 40 saves thousands of lives that otherwise would be lost if the task force’s recommendation for less frequent screening is adopted.
ACR would like to express its appreciation to its leadership and membership for its unwavering support of these legislative efforts. Without their valuable contributions, these legislative victories would not have been possible.