President's Viewbox

Members of the WSRS Executive Committee:

This is a report of our WSRS activities at last week’s ACR Annual Meeting and Chapter Leadership Conference. Our main goal was to influence our United States Senators and Members of Congress to appreciate and support our issues,  consistent with the advocacy positions of the ACR at the national and state levels.

Federal Level:
On Wednesday May 18, about 300 rads visited Capitol Hill to lobby their Members of Congress and Senators about issues important to our profession and our patients. Of the many issues (tort reform, SGR, self-referral) our WSRS delegation focused on a single looming threat.  The MedPAC (Medicare Payment Advisory Commission) has proposed to CMS that the MPPR (multiple procedure payment reduction) that has heretofore be limited to the technical component only, will now be applied to the professional component.  This means that for a CT Chest, Abdomen, and Pelvis, the rad would be paid 100% for reading the chest, and only 50% for each subsequent body part. A backgrounder regarding this proposed new billing threat is given below.

Your Washington State Radiology Society delegation visited the office of Rep Jay Inslee, Rep Jim McDermott, and Rep Cathy McMorris-Rodgers. In the afternoon, after all other members had left for Seattle, I remained to visit the offices of Rep Reichert, and Senators Cantwell and Murray. Owing to a last minute schedule change, I was not able to visit Rep Reichert, but I was able to lobby the senior legislative aides for healthcare legislation for both Senators Cantwell and Murray on the folly and risk of applying the MPPR to the professional component of our billing.  
Our delegation lobbied vigorously for the approval of resolution 44, permitting the ACR to recommend a new residency pathway combining both diagnostic radiology and IR in one 4 year program to the AGCME (Accreditation Council for Graduate Medical Education). Our efforts “working” the delegates was noticed (please see email below) and the resolution was passed.
I have sent handwritten thank you notes to each aide who met with us, and I will follow up with each in about 2 weeks. By the way, because all US Postal Service mail sent to Congress must first be screened for anthrax at a central facility, and as a result it takes about 8 or 9 weeks before the letter reaches that Member of Congress. To avoid this delay, send  your letters should you wish to Ted Burnes at RADPAC and  he will hand deliver the letters to each office.

State Level:
Regarding state legislative issues that are important to Inland, I have attached a letter that I have written to Gov. Gregoire regarding the corrosive effect of “balanced billing” legislation on several WA State subspecialty groups, including radiology.

The WSRS was awarded an ACR Certificate for Excellence in Member Communication. This award represents a sustained effort by several executive committee members over the past years, and their hard work was rewarded with this honor. Only 16 chapters of the ACR received Certificates for a variety of topics at this year’s meeting.  

These efforts and accomplishments would not be possible without your financial support of the Inland Imaging Legislative Advocacy Group and your generous support of RADPAC.
Please email or call me if I can be of any assistance on these or any other matters relating to medical political advocacy.

Sincerely,
Justin P. Smith, MD
WSRS 2011 President

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Oppose Application of a Multiple Procedure Payment Reduction to the Professional Component of Diagnostic Imaging Services

Background: In response to incorrect perceptions by some policymakers surrounding utilization of diagnostic imaging services, the practice of radiology has endured substantial reimbursement cuts implemented both through the legislative and regulatory process.

In recent years, the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS) sought to control imaging growth through reimbursement cuts that impose a Multiple Procedure Payment Reduction (MPPR) to multiple diagnostic imaging services administered to the same patient during a single office visit. MedPAC and CMS traditionally applied MPPR policies to the technical component of advanced diagnostic imaging services, or the cost of equipment, non-physician personnel, and medical supplies. In theory, MPPR policies are designed to lower Medicare costs and improve program efficiency by modifying multiple payments for services performed consecutively on the same day.

Yet, in April 2011, MedPAC took the unprecedented step of unanimously approving a recommendation to apply a MPPR policy to the professional component of diagnostic imaging services. This would result in an inappropriate reimbursement cut to the value of physician-radiologist interpretations of examinations that usually contain hundreds of images and providing the results of this analysis into the final written medical report for the referring physicians.

Issue: Application of a MPPR to the professional component of diagnostic imaging services performed on the same patient on the same day is an arbitrary and imprecise tool to control Medicare spending. The particular recommendation overestimates perceived efficiencies within the professional component, is not supported by sound data, nor was it developed with substantial physician input.

Since each imaging study produces its own set of images requiring individual interpretation, the radiologist is ethically and professionally obligated to expend the same amount of time and effort, regardless of the date of service.

Because reductions to the professional component primarily impact radiologists who, as referral-based physicians, rarely order the imaging studies they are asked to interpret, MedPAC’s recommendation also fails to adequately address inappropriate utilization. Imposition of this policy will also make it difficult for radiologists to keep free-standing imaging facilities open for business, thus threatening patient access to important diagnostic imaging services.

Recommendation:
 Congress must oppose any attempt, either through legislation or regulation, to apply a multiple procedure payment reduction to the professional component of diagnostic imaging services performed for the same patient, irrespective of the date of service or practice setting.
 Recognizing that MedPAC is an unelected, Congressional advisory body, urge Congress to conduct a thorough, independent analysis of MedPAC’s MPPR recommendation.