House committee questions proposed self-referral limits
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Many in the radiology community, including the American College of Radiology (ACR), have lobbied for reform of the Stark provisions of the late 1980s and early 1990s, which limit self-referral but allow widely used exceptions for in-office ancillary imaging services. Opponents charge that the exceptions have contributed to overutilization and are commonly used for advanced imaging procedures, which critics claim were not originally intended for exemption at the bill’s passage.
In light of widespread attention to the growth of medical imaging, overexposure to radiation and pressure to cut healthcare spending, the Centers for Medicare & Medicaid Services (CMS) has looked into reforming the Stark Law and limiting reimbursement for self-referrals.
In a May 20 letter to Glenn M. Hackbarth, JD, chairman of MedPAC, leaders from the House Energy and Commerce Committee’s Subcommittee on Health insisted that MedPAC reconsider its vote to reduce payment levels and packaging for imaging.
Although utilization and spending on imaging grew dramatically between 2000 and 2005 in the wake of broader applications of PET, MRI, digital mammography and other technologies, the passage of the Deficit Reduction Act of 2005 and additional Medicare reimbursement reductions began to limit these increases. “Since that time, growth has been dramatically reduced,” argued Reps. Joseph R. Pitts (R-Pa.) and Frank Pallone (D-N.J.), chair and ranking member, respectively, of the Subcommittee on Health.
According to the Government Accountability Office (GAO), Pitts and Pallone noted, Medicare cut reimbursements by $1.7 billion following the passage of the Deficit Reduction Act, after which the growth in spending on imaging flattened to 2.9 percent in 2008 and 2.1 percent in 2009.
“It is important to note that previous scheduled reductions to payment levels for imaging services have yet to be implemented,” the letter continued. Planned cuts include increasing the assumed utilization of advanced imaging equipment to 75 percent and an increase in the multiple procedure payment reduction from 25 percent to 50 percent over the next four years.
Moreover, Pitts and Pallone pointed to the Medicare Improvements for Patients and Providers Act of 2008’s implementation of accreditation requirements for advanced imaging providers and Medicare demonstrations of appropriateness criteria as poised to further limit spending on imaging.
Although the letter referenced cuts planned under the 2010 Patient Protection and Affordable Care Act, it made no mention of the House’s recent passage (235 to 193) of Representative Paul Ryan’s (R-Wis.) proposal to replace traditional Medicare with the equivalent of individual subsidies or vouchers. The Senate voted down the Ryan Plan last week, 57 to 40.