July 19, 2006—The hearing held yesterday to evaluate HR 5704, the Access to Medicare Imaging Act that would delay DRA cuts to Medicare imaging reimbursement by two years, began on a note of contention.

Rep. Nathan Deal (R-Ga) noted that those cuts and others enacted by the DRA, about which he spoke proudly, were a “major component” in preventing physicians from taking a 4.4% fee reduction. He acknowledged the uproar over the imaging cuts, which were signed into law without the usual hearings, but noted that few of the incensed parties were offering alternate solutions. “Everybody wants to go to heaven,” Deal said, “but nobody wants to die.” He urged members of Congress to consider the explosion in the use of imaging services over the years, noting that one potential reason for the swift growth could be “physicians supplementing their rates with ancillary services.”

It was an ominous start, but the tone of the hearing shifted rapidly as HR 5704 cosponsors offered their opening statements. Rep. Charlie Norwood (R-Ga) said, “Has there been a growth in the use of diagnostic imaging? Of course. Should this growth come as a surprise? As in the rest of the health care industry, innovation does not save money up front.” Rep. John Dingell (D-Mich) added, “Our utmost concern should be that Medicare beneficiaries have access to high-quality services.” And Rep. Lois Capps (D-Calif) said, “I am deeply disturbed by the cuts that were included in the DRA . . . We know that early detection equals early treatment, which saves lives. Of course, it also saves money.”

The first panel to offer recommendations consisted of Herb Kuhn, director of the Centers for Medicare and Medicaid Services (CMS), and Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission (MedPAC). Hackbarth defended the growth in imaging services, saying that “there have been tremendous improvements in the quality of imaging techniques, and techniques that lead to better health care for patients may result in reduced spending on other types of services.” But he tempered this statement by noting that MedPAC sees “wide variation across the country” in the use of imaging for Medicare beneficiaries, even in contiguous, demographically similar states—an observation that leads him to believe there is some misuse of imaging.

When Norwood took the floor, he grilled Hackbarth and Kuhn on the overutilization issue and they failed to respond with the specific information Norwood sought. He asked what percent of growth in imaging was caused by the increase in mammograms; Kuhn and Hackbarth did not know. He asked what percent of growth came from MRI and CT, and again the panel drew a blank. They mentioned a study that proved doctors were attempting to pad their income with unnecessary imaging procedures, to which Norwood responded with skepticism: “You and I have been in this town long enough to know you can make a study saying anything you want it to say . . . Proof is pretty important because you’re claiming this is one of the major causes of increases in imaging costs.” Later, Norwood opined that “MedPAC and CMS have no clue what they’re talking about. They proved that all morning.”

The second panel, consisting of professionals from across the imaging field, was quick to defend diagnostic imaging. Donald Rucker, MD, vice president and chief medical officer of Siemens Medical Solutions (Malvern, Pa), testifying on behalf of the National Electrical Manufacturers Association (NEMA of Rosslyn, Va), noted that the growth in imaging must be viewed as an offshoot of the explosion in computing technology. Landis Griffeth, MD, director of nuclear medicine at Baylor University Medical Center, added, “Drastic reimbursement cuts will not decrease health care expenditures.”

The panel also offered recommendations for limiting imaging costs and adopting standards to improve quality. Arl Van Moore, MD, chair of the American College of Radiology’s (ACR of Reston, Va) Board of Chancellors, suggested the expansion of current CMS regulation of independent diagnostic imaging facilities to all providers, more widespread use of accreditation models—a suggestion also made by Pamela Douglas, MD, chief of cardiovascular medicine at Duke University Medical Center—and implementation of previous MedPAC recommendations for imaging center quality and safety standards.

 “Any of these standards will improve the quality of imaging services for Medicare beneficiaries and achieve the savings that the DRA was intended to capture,” Moore said. “Embracing the ideas that we have articulated will benefit both patients and the health care system, which is our goal.”

—Cat Vasko