On June 24th, selected members of the American College of Radiology (ACR) urged the U.S. House of Representatives Rural Caucus to reconsider the proposed imaging equipment utilization rate change from 50 to 95 percent. The utilization assumption is the percentage of a facility's operating time that the equipment is in use--a key component of the Medicare reimbursement calculation formula. If the assumption is dramatically higher than the amount of time a facility's machines used, the center will be significantly underpaid for their services, according to the ACR.

In rural areas, where reimbursement is already significantly lower than in major metropolitan areas, this proposal will be particularly devastating, says Cassandra Foens, MD, FACR, a radiology oncologist at Covenant Cancer Treatment Center in Waterloo, Iowa. Other panelists selected by the ACR included James Borgstede, MD, FACR, vice chair of radiology at the University of Colorado, and Michael Graham, MD, PhD, vice chair of radiology and director or nuclear medicine at the University of Iowa.

Also participating in the Capitol Hill briefing were Sheila Ross, special counsel for the Lung Cancer Alliance and cancer survivor; Alison Levin, executive director-Ozark Affiliate of the Susan G. Komen for the Cure; Jasmine Greenamyer, vice president of the Colon Cancer Alliance; and Tim Trysla, executive director of the Access to Medical Imaging Coalition (AMIC).

The expert panel emphasized that imaging cuts--on top of those implemented by the Deficit Reduction Act (DRA) of 2005--would have a devastating effect on the ability of rural physicians to provide much needed imaging care to patients. An arbitrary 90 to 95 percent utilization rate for CT and MRI scans, the panel pointed out, would result in at least a 30 percent reimbursement cut, with even more reductions being considered in the CMS' proposed Physician Fee Schedule Rule.

These changes will greatly impact access to advanced imaging services in rural areas of our country. "The typical rural imaging center uses their equipment 48 to 50 percent of the time," Dr. Borgstede explained. "The proposal that this would ramp up utilization expectations to 95 percent of the time will drive even further imaging centers out of business. They're just not going to be able to provide that service."

Dr. Graham notes the likely impact on patient care: a backlog at most imaging centers means very long wait times and longer commutes for treatment. "This is what it takes if you're going to be able to keep the patients coming in and utilizing the machines at a 95 percent level. That really is not the optimal level for patient care. I wouldn't want to run at that level with our machines."

Wait times are not the only concern, said Dr. Graham, also president-elect of the Society of Nuclear Medicine. Advanced imaging exams, particularly in nuclear medicine, more and more are being used to assess response to therapy at an early stage so the course of treatment can be altered, if needed. Treatment planning will be greatly impacted. In addition, access issues to imaging exams will lead to far more invasive and surgical procedures. "[These procedures] may or may not benefit [patients] because we have not been able to adequately assess their disease before we start treating them," Dr. Foens said.

Dr. Borgstede reiterates the organization's mantra: "We want the right image at the right time."

Ross, who at the briefing demonstrated the size of a tumor that can be missed with a chest X-ray versus the size of one detectable by a CT scan, poignantly asked attendees which test they would want. "When you get it caught early, you're not only going to save lives, you're going to reduce costs tremendously. Imaging isn't the problem, it's the answer."

View highlights from the briefing here.

(Note: When you click on the link above, it will open to YouTube in a new browser.)

Kerri Reeves is senior associate editor of ADVANCE.