Local, State, Federal

The Bill Box

By Cat Vasko

Health IT Bills: Spring Roundup

On May 21, Rep Phil Gingrey, MD, (R-Ga) introduced HR 2377, the ADOPT HIT Act, which would change sections of the Internal Revenue Code to provide financial incentives for physicians to adopt health information technology (HIT).

“A recent RAND study found health IT could save the American health care system more than $162 billion a year,” Gingrey said. “But if a doctor can’t afford it, patients can’t benefit from it. By allowing our tax code to help offset the substantial initial cost, my legislation will deliver this critical technology to physicians and patients across America.”

The ADOPT HIT Act includes provisions to amend the Internal Revenue Code to increase the deduction allowed for the purchase of qualified health care information technology by health care professionals; to more than double the first year deduction of rapid depreciation for qualified health IT equipment from $100,000 to $250,000; and to increase maximum purchase costs for qualifying equipment from $400,000 to $600,000 in any given year.

“The health care sector is woefully behind in using this technology,” Gingrey said. “I can go to Antarctica and get cash from an ATM without a glitch, but should I fall ill during my travels, a hospital there couldn’t access my medical records or know what medications I take. Our banks shouldn’t be more technologically advanced than our doctors’ offices.”

In other news, Rep Bart Gordon (D-Tenn), chairman of the House Committee on Science and Technology, introduced legislation on May 22 that would authorize the National Institute of Standards and Technology (NIST) to establish guidelines and mechanisms to promote the integration of the US health care information enterprise. HR 2406 is based on comments gathered from industry stakeholders, patient advocacy groups, and the President’s Information Technology Advisory Committee.

“Current federal efforts have made slow progress in this arena, and in this age of rapid technological advancement, that’s unacceptable,” Gordon said. “This bill, and the development of interoperability specifications, is the logical first step in deploying and utilizing IT in our health system.”

The Committee on Science and Technology approved another health IT bill on May 23: HR 1467, otherwise known as the 10,000 Trained by 2010 Act. This legislation would authorize the National Science Foundation to award grants to colleges and universities to research and support the education and training of health care informatics personnel through newly established degree programs or multidisciplinary Health and Medical Informatics Research Centers.

“While everyone is talking about adopting these systems, no one is addressing the workforce concerns,” said Rep David Wu (D-Ore), chairman of the Technology and Innovation Subcommittee, who introduced the bill. “There are insufficient numbers of health IT professionals and a lack of programs to train current doctors and nurses. A workforce capable of innovating, implementing, and using electronic health systems will be critical to the successful transition. Education will be key to digitizing the health care industry.”

Finally, Senate Health, Education, Labor, and Pensions Committee aides were circulating a draft health IT bill to health care organizations off Capitol Hill shortly before the Memorial Day recess. The groups were urged to file comments by June 4, and committee action could occur this month.

Access to Medicare Imaging Act Introduced in Senate
On May 8, Sens Jay Rockefeller (D-WVa) and Gordon Smith (R-Ore) introduced S 1338, the Access to Medicare Imaging Act of 2007. The legislation, introduced into the House in April, calls for a 2-year moratorium on the imaging cuts called for by the Deficit Reduction Act of 2005.

“We are very concerned that patients who depend upon imaging services outside of the hospital setting, especially those patients in rural and underserved areas, will be particularly hard hit,” said Rockefeller. “Given the haste in which the DRA ’05 legislation was crafted, it is imperative that we institute a 2-year delay to allow enough time for a thorough analysis by the Government Accountability Office (GAO). We should have a better understanding of the complexities and impacts brought about by these cuts before moving forward with a potentially damaging policy.”

The legislation has 101 supporters in the House and 16 in the Senate; cosponsors come from either side of the aisle.

ACR Economics and Health Policy Update
So far, 2007 has seen “the perfect storm” regarding economics and regulatory affairs in the radiology industry, according to Maurine Spillman Dennis, MPH, Senior Director of Economics and Health Policy at the American College of Radiology (ACR), Reston, Va, who took the stage during the 2007 Radiology Summit of the Radiology Business Management Association (RBMA), held in May.

Dennis observed that five forces are impacting the Medicare Physician Fee Schedule (MPFS) this year: The implementation of the Deficit Reduction Act of 2005, new practice expense methodology to be phased in over the next 4 years, multiple procedural reduction holding at 25%, the third 5-year review of CPT codes, and changes to the conversion factor.

Reviewing the impact of the DRA, Dennis listed biggest hits by lost revenue. MRI of the brain topped the list, followed by MRI of the spine, myocardial perfusion SPECT, carotid artery duplex, color Doppler echocardiography, and PET and PET/CT. “I’m sure this is no surprise to most of you,” she said, adding that the ACR would have hard numbers on the financial loss soon. Regarding the origins of the deleterious DRA cuts, she said, “We have a theory that this came from the political side of CMS. We’re hoping that we can start things anew—we’ve had a lot of meetings on the Hill focusing on the impact of DRA and what we can do to get a repeal.”

She also noted one upside: “Prior to this, the ACR was, politically, a lone wolf. Once the DRA came around, we were able to join forces with industry and other specialties. Cardiology has recently joined the Access to Medicare Imaging Coalition [AMIC of Reston, Va].”

During Dennis’s review of the CMS Practice Expense Methodology, the crowd laughed at her slide titled “Intuitive and Easily Understood.” She noted that CMS asked for a supplemental survey on the methodology, which the ACR turned in—but only 10 groups chose to participate. “CMS got a lot of feedback from other specialties wanting a new survey,” she said, which delayed implementation of suggestions.

Dennis then transitioned to a discussion of MedPAC and the Sustained Growth Rate (SGR), which the American Medical Association, backed by the medical community, has been pushing to have fixed or replaced. Though the group was charged with making recommendations to Congress in March regarding possible solutions to the problem, they “didn’t come up with anything specific,” she said. “At the end of the day, the feeling was, let’s study this more. So we’re going to continue to work with MedPAC.” Two things the ACR hopes to avoid when pursuing SGR legislation are lumping in radiologists’ professional work with technical expenses and the establishment of a separate conversion factor for radiology, which could make the field a target.

To finish with a little good news, Dennis noted that those who are behind on their National Provider Identifiers (NPIs) can breathe a sigh of relief. Two major challenges are obstructing the implementation process, she said: Not all providers have acquired NPI numbers, and there have been significant delays related to software testing and crosswalk accessibility. “It’s still a work in progress,” she told the audience. “We think there will be an extension on the contingency period. NPI is not ready for prime time.”

Medicare Will Expand Coverage of Diagnostic Ultrasound
On May 22, the Centers for Medicare and Medicaid Services (CMS) announced its decision to provide coverage for Doppler monitoring of cardiac output in certain settings. The agency has determined that the current evidence is adequate to revise the longstanding Ultrasound Diagnostic Procedures section of the National Coverage Determination (NCD), available for download at www.cms.hhs.gov/manuals/downloads/ncd103c1_Part4.pdf.

CMS will amend the NCD at section 220.5 of the manual, adding to the list of covered uses “Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU and operative patients with a need for intra-operative fluid optimization.” Cardiac output monitoring is used to guide intravenous fluid replacement and pharmacologic therapy for patients undergoing surgery or those in the intensive care unit.

“Today’s decision reflects CMS’ commitment to using evidence-based approaches to provide Medicare beneficiaries with reasonable and necessary medical technologies as they evolve through innovation in the marketplace,” said CMS Acting Administrator Leslie Norwalk, Esq. “As we developed this decision, we used the best available medical evidence—in the form of randomized controlled clinical trials—to re-evaluate our position on this important noninvasive method of caring for patients in intensive care situations.”

Using esophageal Doppler to assess cardiac output is noninvasive, can be completed in minutes, requires minimal technical skill, and is not associated with any major complications. CMS was asked to reconsider its longstanding NCD on ultrasound diagnostic procedures by Deltex Medical Group PLC, Chichester, UK, which manufactures the CardioQ esophageal Doppler monitor. The company asserted in its reconsideration request that the existing NCD predated both the CardioQ and analogous devices as well as much of the validation data and the peer-reviewed, randomized, controlled clinical trial data.

Compliance Strategies for Handling Third-Party Payor Audits
At the May 2007 Radiology Summit of the Radiology Business Management Association (RBMA), Andrew B. Wachler, Esq, of Wachler and Associates PC, took the podium to explain defense and compliance strategies for third-party payor audits. These audits may become increasingly common, Wachler noted, as cuts from the DRA and other regulatory issues draw attention to potential overuse of radiology services.

“One might think, why talk about it if I’m not being audited?” he said. “But a change is occurring. We’re seeing some cuts owing to utilization concerns. And we’re seeing things now that will increase the likelihood of being audited.” Wachler stressed that most payors leave themselves ample room to deny payment. “Services are subject to medical necessity review,” he noted. “In many audits, payors say, maybe it was necessary, but the necessity is insufficiently documented.” Key compliance risk areas include off-site reading, using an employee versus an independent contractor, and teleradiology.

To decrease your risk of falling victim to a payor audit, Wachler stressed three main tips. First, if you call your carrier for billing directions or guidance, document the answer you receive in real time. If you behaved exactly according to their answers, you are a provider without fault, and you are entitled to keep your money. Second, according to what’s known as the waiver of liability, if you did not know and did not have reason to know services provided were not medically necessary, but acted on good faith, you are entitled to payment.

Third, remember the treating physician rule. It says that the treating physician—which in the case of radiology would be the ordering physician—knows more than what is officially on the record and has more experience than the auditor. “You’re supposed to win in the case of a tie,” Wachler noted.

Cat Vasko is associate editor of  Axis Imaging News. For more information, contact .