Continuing to look ahead at the potential impact of the Deficit Reduction Act of 2005 (DRA), the American College of Radiology (ACR), Reston, Va, is pushing forward with its member education and Congressional lobbying efforts. In a live April webcast, ACR Board of Chancellors Chair James P. Borgstede, MD, discussed with members the efforts of the ACR movement seeking appropriate reimbursement for the technical component, and also recapped some of the background on how medical imaging came under the chopping block in the DRA.
And while the ACR is lobbying for its cause, the American Medical Association has remained silent on the issue. A spokesperson from the AMA said that the association does not publicly comment on issues it does not have policy on. Borgstede says the ACR has a continuous dialogue with the AMA—albeit behind the scenes—and that the organization is sympathetic to their efforts.
“Radiologists are AMA members, and we’d like the AMA to support their members,” he says. “The AMA always talks about how ‘together we’re stronger,’ so we would hope that they would consider us part of the ‘together.'”
Borgstede says outpatient radiology reimbursement got a double hit: first through CMS with its 50% reduction in the technical component for contiguous body part imaging in the outpatient setting, and second through the DRA set to go into effect in 2007. He is optimistic that Congress and CMS will look at the issue this year, and the ACR hopes to facilitate both sides to reach what they believe is an appropriate reimbursement rate.
“The problem is that they really have two discrepant reimbursement schemes, and they need to merge those into one appropriate reimbursement scheme,” Borgstede says. “We’ve actually worked…with CMS to implement some of the practice expense data that the Practice Expense Advisory Committee has developed over the last 5 years. Then on the legislative side, what we’d like to see is either the reversal of the section 5102B in the Deficit Reduction Act, or, if not, a delay while we study how this could be more appropriately implemented.”
While Congress is certainly no stranger to getting involved with physician reimbursement—Medicare is the largest single payor in physician reimbursement—Borgstede says it is more disturbing that Congress added those cuts without consulting any outside sources: the ACR, hospitals, vendors, or other physician groups.
“What they’ve really done is to throw out the entire 15-year-old RBRVS, which really values physician’s services based on a very logical methodology that has research basis, and is validated by 25 other specialties,” he says. “Clearly, those specialties aren’t going to overvalue one specialty’s services because it affects their reimbursement as well. We think that the RBRVS and the way practice expense is valued though the Practice Expense Advisory Committee is the appropriate way. Physician services are valued on the resource cost that is needed to provide them, and that’s the way we think this thing should go.”
Activity Prior to PET Triggers False Positives
While it is common knowledge that exercise is good for your health, many may not know that activity prior to a PET scan is to be avoided at all levels.
According to an article in the March issue of the Journal of Nuclear Medicine Technology, any type of physical activity that takes place within 48 hours of receiving a PET scan—from lifting weights to chewing gum—can lead to false-positive results.
“What constitutes physical activity is excessive muscle activity that is out of the usual, normal daily activities,” says Medhat M. Osman, MD, ScM, PhD, the study’s coauthor and director of PET at St Louis University Hospital.
The authors investigated, head to toe, how excessive physical activity can lead to a false-positive reading. When imaging cancer, a radiopharmaceutical is injected in a patient. Cancer cells metabolize sugar faster than normal cells do, creating a higher uptake in the cancerous regions, which the PET scan picks up. When patients exert themselves, the radiopharmaceutical will be drawn to those used muscles, creating a false positive.
“Any of these muscles will light up; if someone is reading a book and flipping pages during the uptake phase, then we can see some uptake in the forearms,” Osman says.
He encourages patients to tell technologists of any activity so that it can be reported to the reading physician. He also encourages technologists to ask the right questions and make sure to observe the patient prior to the scan.
“The bottom line is for the patient to report to the technologist the kind of activities they were doing 24 to 48 hours prior to the scan, as well as for the technologist to report their observations of what the patient is doing during the uptake phase that will minimize any potential false-positive interpretations for the scan,” he says.
A patient should reschedule the scan if it is determined that their particular activities will limit or hinder the interpretation, he says. Keeping an open dialogue between the technologist and reading physician is important so the patient is not subjected to unnecessary scans.
“If I know that the patient has melanoma and it is in the legs, and I know that the patient exercised on a treadmill the day before, then that small lesion may be masked by the extensive uptake in the muscles of the legs,” Osman says. “That will decrease the sensitivity of the scan. Would that potentially risk the accuracy of the study or can we deal with it as long as we know what we are up against? We have to take this on a case by case basis.”
Practice Expenses: It Costs How Much?
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A review of MGMA Cost Survey Reports from 1995 to 2005 using the previous year’s data reveals that the total operating costs among all multi-specialty practices grew 44% between 1994 and 2004 (median value per full-time-equivalent physician). While all of the other operating cost categories increased, radiology and imaging was the only category to decrease, from $5,237 in 1994 to $4,866 in 2004. According to Dan Stech, director of survey operations for the MGMA, several factors play into the data showing a flat spending rate on radiology and imaging services for those 10 years. First, the data includes hospital-owned groups, which tend to keep those procedures in the hospital. Second, physician-owned multi-specialty groups may have payor contracts preventing them from offering such services. As such, those groups may have a separate business for radiology and imaging services, and the Cost Surveys will not show that data. “Many of these multi-specialty practices are comprised mainly of primary care physicians,” he says. “The cost of technology, clinical guidelines, payment rules, and other obstacles inhibit their offering such services.”
Merge Healthcare, Burlington, Mass, has named Robert J. White as president of Merge eMed…Mark Doda has been named president of DMS Imaging, a member of the DMS Health Group, Fargo, ND…A. Redmond “Rusty” Doms, Jr, has been elected to the board of directors of Radlink Inc, Redondo Beach, Calif…Intelerad Medical Systems, Montreal, has named Rick Lee to run its new office in Melbourne, Australia…The American Healthcare Radiology Administrators (AHRA), Sudbury, Mass, announces that 33 radiology administrators who took the March Certified Radiology Administrator (CRA) examination received a passing score. The new CRAs are: Anita L. Apodaca, Albuquerque, NM; Debra A. Casey, Elkton, Fla; Stephen C. Chaudoir, Berrien Springs, Mich; David Childers, Rockford, Ill; John R. Detelich, Tallahassee, Fla; Tom Gaston, Massillon, Ohio; Teresa Glenn, Georgetown, Tex; Robert L. Hake, Olympia, Wash; Linda Hansen-Allen, Jacksonville, Fla; Mark Hays, Lake Elsinore, Calif; Deborah Heatter, Georgetown, Tex; Karen Herczeg, Rochester, NY; Jeffrey Holland, Akron, Ohio; Terry R. Hurlbert, Highlands Ranch, Colo; Lesley Kibel, Grand Junction, Colo; Brian Matsusaka, Kailua, Hawaii; Dawn L. Miller, Galesburg, Ill; Diane M. Nelson, Jamestown, ND; Rebecca M. Pryor, Cincinnati; Debra Rickard, Evansville, Ind; Susan G. Rucks, Willmar, Minn; Jose R. Serpa, Kingston, NY; Eric L. Sisk, Killeen, Tex; Katherine A. Steffen, Indianapolis; Jason C. Theadore, Dublin, Ohio; John Tkach, Cumberland, RI; Michael T. Tutor, Paducah, Ky; Linda Walla, Hagerstown, Md; Robert Weisbecker, Milwaukee; Robert S. Wilson, Orlando, Fla; Julie A. Wolowitz, Evansville, Ind; Clark G. Yoder, Trumbull, Conn; and Brad Zeller, Hayward, Wis.
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