Members of Congress recently introduced bipartisan legislation aimed at bolstering Medicare beneficiaries’ access to diagnostic imaging agents.
Current federal payment rules prevent safety-net hospitals and other providers from affording certain radiopharmaceuticals, leaving many without access to cutting-edge diagnostics. Rep. Bobby Rush, D-Ill., and others have proposed the Facilitating Innovative Nuclear Diagnostics Act of 2021 to close such care gaps.
“We cannot tolerate a two-tiered healthcare system—one for the rich, and one for everyone else,” said Rush, who is sponsoring the bill alongside Reps. Scott Peters, D-Calif., Neal Dunn, R-Fla., and Greg Murphy, R-N.C. “Unfortunately, many low-income and minority patients are being denied access to the most efficient tests, therapies and care due to the current payment structure for diagnostic radiopharmaceuticals that makes it nearly impossible for many hospitals serving our most vulnerable populations to offer these lifesaving diagnostics.”
The FIND Act would guarantee adequate Medicare reimbursement to hospitals that use nuclear agents to diagnose, evaluate and treat certain cancers, Alzheimer’s disease and other concerns. Rush said the bill is budget-neutral and would not require tax increases to cover such care.
Both Rush and Peters blasted the Centers for Medicare & Medicaid Services “flawed” payment policy for such drugs in April, prompting a meeting with the agency. Since 2008, CMS has treated radiopharmaceuticals as “ancillary” to the imaging procedure in the hospital setting, resulting in them being “policy packaged” into the procedure amount in payment classifications. However, this system fails patients, the lawmakers said, as the cost of imaging agents often outstrips the procedure tally. Their proposal would direct the feds to pay separately for all diagnostic radiopharmaceuticals with a cost threshold of $500 per day.
Industry lobbying group the Medical Imaging & Technology Alliance applauded the proposal Tuesday, anticipating it will significantly expand Medicare users’ options.
“The FIND Act represents a much needed, bipartisan legislative solution that would modernize CMS payment policies for diagnostic radiopharmaceuticals and expand beneficiary access to diagnostic modalities that can improve outcomes and reduce downstream medical costs,” Sue Bunning, MITA’s industry director of molecular imaging and PET, said July 20.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.