Washington 2013: Imaging at the Grindhouse

Imaging has been through a long legislative and regulatory grind since the first big blow was struck with the DRA, and there is little to indicate that much will change on that front in 2013, according to Ted Burnes, MPA, director of RADPAC, the political-action committee of the ACR®. With Maurine Dennis, MPH, MBA, a consultant for the RBMA, Burnes copresented “Radiology Economics and RADPAC Update” on May 22, 2013, at the RBMA Radiology Summit in Colorado Springs, Colorado. Burnes explains that a pre-election year—especially one as contentious as this one, in which both parties are hoping for a shift in the balance of power in Congress—is all about messaging (as opposed to legislating) for lawmakers. “Everything they do is a messaging agenda,” he says. He points to the recent 37th vote for repeal of the Patient Protection and Affordable Care Act (PPACA), a largely symbolic gesture undertaken by a Republican-controlled House of Representatives that knows that its efforts toward repeal won’t get past the Senate, much less the White House. The vote was an opportunity for freshman lawmakers to indicate their opposition to the PPACA prior to voting on changes to it, which might be interpreted as tacit approval. Thus, bystanders can expect little in the way of action on repealing the Multiple Procedure Payment Reduction (MPPR) for the professional component implemented in the 2012 Medicare Physician Fee Schedule (MPFS), and the medical-device tax is likely to be here to stay as well. “It will be hard to overturn this because it produces $30 billion in savings,” Burnes notes. “It’s hard to find a number to replace that, if it goes away.” Self-referral also is a nonstarter this year, he believes. While a previous assessment had estimated that $6 billion could be saved over 10 years if legislation to curb self-referral were to be approved, a more recent Congressional Budget Office estimate scored the savings attributed to imaging at $1.8 billion. “That is just not enough to sway members of Congress,” Burnes says. Some minor bills pertaining to reimbursement for the work of radiologist assistants and radiologic technologists also are likely to fall by the wayside: He says, “We’re lucky if we can get two things in a meeting that we can pitch on the Hill.” Potential Wins and Losses The current environment means that RADPAC is saving its firepower for bigger initiatives, including a utilization-management policy focused on mandating physicians’ use of clinical-appropriateness guidelines for medical imaging. This was “very well received on the Hill,” Burnes says, and the family-physician community has indicated its support (in an informal manner). Burnes also reports that Congress is amenable to working on the formula for the sustainable growth rate this year. One House bill is “heavily weighted to primary care,” he says, while another proposal, in the draft stage, suggests undergoing a three-phase process: first, transitioning to more predictable payment rates; second, reforming the Medicare payment system to provide better incentives for high quality; and third, reforming to account for efficiency of care. “There is interest in doing decision support, which is perfect for us,” Burnes says. “We feel that there’s good opportunity for us to get some of our legislative issues included in this package.” Dennis took a detailed look at how the proposed 2013 MPFS stands to affect radiology next year. Most troubling, she says, is the renewed focus on potentially misvalued RVUs—which, of course, means overpaid (not underpaid) RVUs. “In their minds, this includes basically all of radiology,” Dennis says. During the 60-day comment period following the release of the proposed rule (expected in July), CMS will accept public nominations for potentially misvalued codes. “No one is going to pay attention if you nominate an undervalued code, but if someone nominates all radiology codes, CMS is going to take a look at that, so this is something to be concerned about,” she notes. Also of interest is a local initiative that might become a national trend: the Colorado Clean Claims Task Force. Piggybacking on a directive from the US DHHS secretary, the Colorado Department of Health Care Policy has developed a standardized set of payment rules and claim edits for providers and payors in the state. The MPPR for radiology was added to the slate. “Needless to say, the ACR and RBMA have been very involved in this issue—it’s ongoing,” Dennis says. “We’ve been working to make sure our voices are heard on the coding side.” Burnes says that providers, including radiologists, should expect no relief from the ills of sequestration anytime soon. “They are already talking about applying the same 2% cuts next year,” he says. “It’s our understanding that it will not be compounded, but it’s too early to determine. When you talk to House Republicans, this is the only way they feel they can control spending out of DC, and they are not budging. This is an issue we’ll deal with for the next two or three years.”