U.S. Capitol

A fractured legislative process, characterized by brinksmanship and intra-party divide produced a partial response to the infamous “fiscal cliff” late last night. The House of Representatives adopted a Senate/White House compromise that will result in raising taxes for incomes over $400,000, and a one-year Sustainable Growth Rate (SGR) “Doc fix” paid in part by increasing the technical component (TC) equipment utilization threshold for advanced imaging modalities from the current 75 percent to 90 percent beginning January 2014.

In an effort to duplicate ACR’s successful 2010 effort that reduced a proposed Centers for Medicare and Medicaid Services (CMS) equipment utilization rate increase of 95 percent to its current 75 percent rate, the ACR fought the inclusion of this provision that would garner approximately $800 million in savings to the Medicare program over a 10-year period. Diagnostic imaging became a “pay-for” in this annual SGR battle because the Democrat-controlled Senate and White House chose not to make any policy modifications to the president’s Patient Protection and Affordable Care Act (PPACA), which had previously offered lawmakers a variety of payment option refinements for savings purposes. Without this set of policies to modify, lawmakers were forced to go to “old lists,” including provisions in the president’s budget, that had existed for the last four years. The ACR and, the ACR co-founded Access to Medical Imaging Coalition (AMIC), have fought these TC payment decreases yearly but could not prevail in this current political environment.

“Reverting to continuous provider cuts to help pay for a morbidly flawed payment policy, in an environment that resembles more ‘Alice in Wonderland’ than ‘Mr. Smith Goes to Washington,’ is an embarrassment to our country and a disservice to our nation’s seniors. These cuts will ultimately damage patient access to medical imaging care and may drive up long term costs by delaying diagnosis of illness and disease to later stages where more expansive, and expensive, treatments are required. This move by congress represents a step backward in patient care,” said ACR Board of Chancellors Chair Paul Ellenbogen, MD, FACR.

During the frantic scramble to avert the fiscal cliff and the latest SGR cuts, lawmakers failed to include H.R. 3269/S. 2347, the Diagnostic Imaging Services Access Protection Act, into the final legislative package that ultimately passed the House and Senate over the last two days. ACR advocated strongly for the bill’s inclusion, yet averting the 25 percent multiple procedure payment reduction to the professional component (PC) generated no savings to the Medicare program and cost-cutting sentiment in Congress prevailed.

“This move by Congress is incredibly shortsighted and unnecessary. It is a failure and lack of vision on the part of our elected leaders who cannot come up with a sensible long term strategy. Unfortunately, this lack of leadership will ultimately harm access to care rather than strengthen the healthcare system for patients,” said ACR Board of Chancellors Vice Chair Bibb Allen Jr., MD, FACR.

The next step in this continuing saga of budget and entitlement reform will start to play out quickly over increasing the nation’s debt limit and the adoption of a federal budget by Congress. The ACR will use the coming weeks and months to try to modify these payment reductions and educate lawmakers to support more informed policy changes to the Medicare program that will not compromise access to quality diagnostic imaging care.