“MedPAC did a really nice analysis of where the volume growth was,” says the House staffer. Members of that panel liked every one of the suggestions presented by the Medicare Payment Advisory Commission (MedPAC). That proposed rules change was based in part on recommendations delivered to the Ways and Means Subcommittee on Health back in March. “We don’t want to be in the business of micromanaging payment policy for very specific parts of Medicare.”Īccording to this staffer, Congress would prefer to let the Department of Health and Human Services (HHS) work things out with rules changes, such as the ones HHS’s Centers for Medicare and Medicaid Services has proposed to implement on January 1. “We’re reluctant to get involved with a legislative solution when CMS has the experts who are more than capable of deciding the clinical appropriateness of care-including what providers should be paid for that appropriate care,” says one Congressional staffer whose boss sits on the House of Representatives’ Ways and Means Committee health panel. While many in radiology would like to see Congress pass laws to help limit the explosive growth of imaging services among nonradiologist physicians (cardiologists in particular), the mood on Capitol Hill is such that no one should expect action on that front any time soon. MOTHER OF NECESSITY Congress Defers to HHS Borgstede, MD, FACR, chairman of the board of chancellors of the American College of Radiologists, Reston, Va, which concurs with that calculus. That makes sense in light of estimates by Moskowitz 2 et al indicating as many as half of all imaging studies performed by nonradiologists are unnecessary, says James P. One way they intend to go about it is by inserting more checks to ensure that the imaging being done is truly appropriate. This growth has not gone unnoticed among private payors seeking to rein in health care costs. A 1994 Government Accounting Office report found that providers who own imaging equipment are 54% more likely to order tests than physicians who refer patients to facilities in which they have no financial stake. Much greater growth rates have been occurring among nonradiologist physicians: cardiologists alone increased their share of the imaging pie by 141% during that same period, according to data from NCQDIS.Īs Miller noted in his testimony before the Subcommittee on Health, a dramatic proliferation of imaging equipment ownership has transpired among nonradiologist physicians in recent years. Cherrill Farnsworth, executive director of the nonprofit National Coalition for Quality Diagnostic Imaging Services (NCQDIS), reports that radiologists in 2002 handled volume only 7% greater than they did in 1993. However, radiologists are not as busy as this implies. More imaging undeniably is occurring these days, a lot more.
MedPAC Executive Director Mark Miller explained to members of the House Ways and Means Committee’s health panel that Medicare spent $9.3 billion on imaging in 2003, up from $5.7 billion in 1999. Imaging is in the crosshairs because it is the one physician service that grew the fastest of any between 19, based on figures compiled by the Medicare Payment Advisory Commission (MedPAC) and presented to Congress in March 2005. As such, lawmakers, regulators, and payors need not have the best of aim (which they do not, to hear radiology professionals tell it) when they let arrows fly (which they are) just being sufficiently exercised about the overutilization of imaging is all it takes right now to guarantee plenty of hits on the broad side of this particular barn. The one at present painted on radiology is about as big and brilliantly red as they get. Bull’s-eyes come in many different sizes, shapes, and colors.
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