‘Outdated’ CMS policies crippling patient access to live-saving molecular imaging, advocates warn
Top nuclear medicine groups are urging lawmakers and other stakeholders to ensure patients have access to the latest life-saving molecular imaging techniques.
A coalition of advocates—the Medical Imaging & Technology Alliance, Society of Nuclear Medicine & Molecular Imaging and Council on Radionuclides and Radiopharmaceuticals, Inc.—voiced their opinions Wednesday during a virtual briefing with physicians, patients and industry representatives.
They called on attendees to support the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021, which would update “arcane” Medicare reimbursement policies.
“Despite having demonstrated health benefits for Medicare beneficiaries, outdated CMS payment methodologies create significant, often insurmountable access barriers to a newer, more precise generation of PET and SPECT diagnostic imaging modalities,” Ann Marie Dawidczyk, chair of MITA’s Coverage, Coding & Payment Committee, said March 3, adding that “these structural reimbursement barriers must be addressed.”
For example, SNMMI and others pushed back against Humana’s recent decision to label hybrid PET/CT exams as “experimental” and “investigational,” restricting reimbursement for such imaging. Shortly after, nuclear medicine experts penned an editorial sharply criticizing the insurance giant, calling the move “ill-informed and wrong.”
Also during the March 3 presentation, Thomas Hope, MD, director of Molecular Therapy in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, outlined molecular imaging’s growing role in detecting prostate cancer, Parkinson’s, Alzheimer’s and other harmful diseases.
“Positron emission tomography using a PET-radiopharmaceutical is a highly effective way to detect prostate cancer throughout the body, allowing for more targeted, selective treatment,” Hope explained. “Given the many benefits of these modalities…I firmly believe that PET imaging is the best way to evaluate patients with prostate cancer.”
A study presented during the American Society for Radiation Oncology Annual Meeting in October back up Hope’s claims. Incorporating advanced PET into treatment planning for patients with recurrent prostate cancer increased disease-free survival rates, prompting Emory University researchers to label it the “best available test” and recommend its use in standard practice.
You can read more about the FIND Act of 2021 here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.