On July 18, the House Energy and Commerce Subcommittee on Health held a hearing on medical imaging services for Medicare beneficiaries. The witnesses testified regarding the cost-effectiveness of medical imaging, such as CT, PET and MRI scans, and ultrasound. Also discussed was the effect of the Deficit Reduction Act of 2005 (DRA) (P.L. 109-171) on Medicare reimbursement rates for hospital outpatient and physician office-based medical imaging services.
Herb Kuhn, director of the Center for Medicare Management at the Centers for Medicare and Medicaid Services (CMS), testified that “Medicare spending for imaging services has been growing rapidly. Between 2000 and 2005, spending for imaging services paid under the physician fee schedule more than doubled from $6.6 billion to $13.7. CMS has four classifications for medical imaging services: “standard,” which includes x-rays, nuclear medicine procedures, and PET scans; “advanced,” which includes CT and MRI scans; “echography,” which includes ultrasound and sonography; and “imaging procedures,” which include cardiac catheterization, fluoroscopy (a technique used to capture live x-ray images that show movement of bodily structures), and 3-D holographic reconstruction. Mr. Kuhn also testified that Medicare will reimburse physician office-based medical imaging at the lesser of either the hospital outpatient or Medicare Part B physician fee schedule beginning January 1, 2007.
Dr. Douglas W. Laube, president of the American College of Obstetricians and Gynecologists, testified on the importance of medical imaging to women. Dr. Laube said, “Medicare patients make up only 13 percent of the average ob-gyn practice. This small but significant percentage includes both older women and women with disabilities of all ages. While’s today’s hearing is focused on imaging in Medicare, the decisions about Medicare policy this Committee may make will be adopted widely by private payers, Medicare and TRICARE, the health care system for 9 million military families. Clearly, women of all ages throughout the country stand to be affected by these decisions.”
Dr. Laube also described the importance of ultrasound in obstetrics and gynecology, not only in pregnancy but also as a diagnostic tool. He cited the cost effectiveness of imaging technology, saying, “Continuous ultrasound improves the safety of third trimester amniocentesis [a prenatal diagnostic test] and reduces costly complications…Ultrasound imaging in clinical practice enables a breast surgeon to perform a minimally invasive breast biopsy and determine whether a lump is cancerous in a matter of days…The Medicare program saved as much as $88 million because of the use of image-guided breast biopsies instead of open biopsies between 2001 and 2003.” He urged the committee to distinguish ultrasound from other imaging techniques in determining appropriate reimbursement and referral guidelines.
Also testifying were: Lynn May, chief executive officer, American Society for Radiologists; Dr. Donald W. Rucker, on behalf of the National Electrical Manufacturers Association; John J. Donahue, president and chief executive officer, National Imaging Associates; Dr. Landis K. Griffeth, director of nuclear medicine at Baylor University Medical Center; Pamela Douglas, on behalf of the American College of Cardiology and the Coalition for Patient-Centered Imaging; and Glenn M. Hackbarth, chair, Medicare Payment Advisory Committee.
