Medicare bill contains fix for physician payment cut, imaging provisions

Sen. Max Baucus, D-Mont. Source: Wikipedia

A bill to prevent a 10.6 percent Medicare physician payment cut scheduled to go into effect on July 1 was introduced last Friday by Senate Finance Committee Chairman Max Baucus, D-Mont.

The bill, S. 3101, the Medicare Improvements for Patients and Providers Act of 2008, also replaces a 5 percent cut set for Jan. 1, with a 0.5 percent positive update for the rest of 2008 and a 1.1 percent update through 2009.

Additionally, the legislation contains two imaging utilization provisions backed by the American College of Radiology (ACR). The first calls for Medicare providers of advanced diagnostic imaging services such as MR, CT, PET and nuclear medicine to be accredited by 2012 to receive payment for the technical component of those services. The Secretary of Health and Human Services will designate private accrediting bodies through its rulemaking process by Jan. 1, 2010, the college said.

The second provision establishes a two-year voluntary demonstration program by 2010 to test the use of physician-developed appropriateness criteria for advanced diagnostic imaging services. The program will gather data at both the point of order and point of service and will provide real-time feedback for ordering physicians. Prior authorization models are explicitly prohibited in the program, according to the ACR.

Inclusion of the imaging measures comes less than three weeks after more than 360 radiologists met with more than 300 congressional offices as part of the ACR Annual Meeting and Chapter Leadership Conference in Washington, D.C. While on Capitol Hill, ACR members advocated for inclusion of the two provisions in the Medicare bill as well as relief from the mandated sustainable growth rate (SGR) cut.

Sen. Charles Grassley, R-Iowa, the ranking Republican on the Senate Finance Committee, has formulated a separate bill, which largely parallels the Democratic version, except in which programs or services would be cut in order to pay for the increased physician payments.

According to the ACR, despite the fact that the Senate did not include further imaging cuts in their Medicare package, the possibility still remains that cuts to imaging services, such as those passed by the House last summer but subsequently spurned by the Senate in December, could be put back on the table as an alternative means of offsetting the cost of the final bill. The Senate and House must pass a bill that President George W. Bush can sign, or override his veto by June 30, to spare physicians from the 10.6 percent cut.

The ACR said it will be working hard and calling on its members to ensure that the physician pay cut is avoided without cutting imaging to offset the cost, and that the accreditation and appropriateness criteria provisions are included in a final Medicare bill.