Raising the Voices of Radiology
Every business has its stressors, and certainly, the past year has been an economic challenge for many different industries. Radiology, however, seems to have endured more than its fair share of obstacles during the recent interesting times in which we live. Having struggled to adapt to the seemingly arbitrary reimbursement cuts of the DRA, which went into effect in 2007, outpatient radiology has now been hit with a far more significant reimbursement cut by CMS. This cut is based on an elevation of the utilization-rate assumption for CT, MRI, and PET from 50% to 90% and a corresponding lowering of the technical-component reimbursement rate by a draconian 40%, for an overall 21.5% reduction in CT and MRI reimbursement. Few businesses can survive mass reductions in revenue such as this, and when the reductions are compounded with additional challenges such as inflation, rising overhead costs, and loss of procedural volume due to self-referral, the result is that many imaging centers are struggling to stay open.

Video of the Emergency Coalition press conference
Those practices that have remained in business have had to make difficult decisions regarding modalities such as mammography, which often function at a financial loss and only are sustained through the subsidization of revenue garnered by the more reasonably reimbursed MRI and CT. As a result, with great reductions in MRI and CT reimbursements, mammography centers have been closing throughout the United States. Even before the DRA went into effect, 26% of all mammography centers in New York City closed between 1999 and 2007 due to low reimbursement. It’s not surprising that the waiting times for mammography appointments in New York subsequently increased 171% due to the increasing scarcity of resources. For Nassau Radiologic Group, experienced leadership that has weathered earlier moments of transformative change has allowed us to make the critical decisions necessary to adapt. With unavoidable decreases in reimbursement, the need to increase volume through expansion and through the development of new modalities (as well as the need for cost reduction) takes on greater importance. Although we are one practice, we have realized that it is imperative to reach out to our elected officials to attempt to forestall the proposed CMS cuts, which threaten the ability of every radiology practice to deliver the best possible access to care for its patients. A Road Map During the spring, even before the CMS ruling was announced, we reached out to experts in the lobbying, insurance, hospital, and political consulting industries. Their guidance has provided invaluable insight, as well as a prognostic road map that has helped us formulate our strategy. Fortunately, our group was not alone in realizing the gravity of the situation before us. Colleagues of ours at neighboring practices on Long Island and in Manhattan were having similar internal discussions. Through mutual professional relationships, we discovered our similarities of intent, and we began discussing our common goals and potential methods for proceeding. Originally, our mutual concern sprang from commentary by elected officials and appointed administrators that strongly implied the desire to limit or ration access to imaging severely. The day that we began our initial face-to-face meeting with what then consisted of seven (now 14) radiology practices, patient care was further threatened with the release of the proposed Medicare Physician Fee Schedule, which almost doubled the assumed equipment-utilization rate. As we had now been unified and motivated by the threat that this would pose to our patients’ access to care, a true grassroots organization, now known as the Emergency Coalition to Save Cancer Imaging, was formed. The coalition is composed of physicians, patients, and community cancer-advocacy groups with no ties to industry, with each member committed to preserving patient access to vital imaging services. The day-to-day operations of the coalition are managed internally by three directors and by a political-communications company that we hired, based on its expertise in creating critical mass awareness among elected officials. We chose a company that had strong experience with health care, as well as strong ties to elected officials in New York. This coincided nicely with advice that we garnered from the ACR, which was to use our local advantage of being constituents of elected legislators representing New York who sit on the Senate Finance Committee and the House Ways and Means Committee. The political-communications company, while not a lobbying concern, has provided forums to get our critical issue noticed by the public, and thus by influential elected officials. One of these forums was a press conference held in September on the steps of City Hall in New York. Four City Council members (including the speaker), as well as the Manhattan borough president, detailed the pending health care crisis that looms for New York, should these cuts to medical imaging be sustained. These speakers were followed by three cancer patients who attribute their survival to early diagnosis made with the aid of medical imaging. One of these patients has agreed to accompany coalition members to Washington to speak on behalf of all of our patients to our elected representatives. Whether these endeavors will help our coalition protect access to vital imaging services for our patients remains to be seen. At this critical time, only if all of us in the imaging community put forth our best efforts and use the resources at our disposal will we have any chance of protecting our practices, employees, and patients. Eric Schnipper, MD, is a partner, Nassau Radiologic Group, Garden City, New York, and is cofounder of the Emergency Coalition to Save Cancer Imaging (www.savecancerimaging.org).