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Heralded by the New England Journal of Medicine as one of the most important "developments that changed the face of clinical medicine" in the last millennium, and dubbed by the National Institutes of Health as one of the most important medical tools of the future, medical imaging services are an essential component of our nation's health system. Nonetheless, as Congress looks to cut budgets even further across the policy spectrum, misinformation about imaging utilization means further cuts to medical imaging are looming--cuts that will restrict patient access to life-saving technologies.
Contrary to what some policymakers have assumed, the rate of growth in imaging utilization rates has flattened in recent years. In fact, imaging is now one of the slowest growing components of the Medicare Physician Fee Schedule. Since 2006, Congress and the Centers for Medicare and Medicaid Services (CMS) have cut imaging reimbursements five times in five years, with several services being cut by more than 60 percent. Even in light of these trends, policymakers continue to propose further reductions to Medicare reimbursement for imaging services, as well as prior authorization--both of which threaten to restrict seniors' access to life-saving medical imaging and diagnostic services.
In addition to continual deep and arbitrary cuts to medical imaging, policymakers also continue to propose the use of radiology benefit managers as a tool for prior authorization, which have never been used previously in Medicare. From the patient perspective, prior authorization would mean placing a barrier between patients and the services their physician believes are necessary, which could lead to delayed or denied care. From the provider perspective, prior authorization means having to devote additional uncompensated physician and staff time to a burdensome administrative process. Additionally, there is also no conclusive evidence showing they improve ordering patterns or yield long-term savings; on the contrary, they create more barriers to patient access.
In a recent American Medical Association survey of 2,400 physicians, 63 percent said they typically wait several days for a response to a prior authorization request and 13 percent said that they generally wait more than a week. These wait times delay diagnosis and care, which can exacerbate a patient's condition and require more intensive or invasive treatment down the road. Alternatives such as promoting the use of evidence-based, physician-developed appropriateness criteria for imaging services can reduce utilization and spending without the unnecessary bureaucracy of prior authorization or the blunt instrument of reimbursement cuts.
Additionally, further reductions in medical reimbursement will force more community imaging centers to consolidate or close, which will in turn cause patients to endure increases both in wait times for appointments and in driving distance to the closest imaging center or hospital. This has already begun to happen. Looking at mammography alone, FDA statistics show that there are 212 fewer mammography facilities and 1,131 fewer mammography scanners available to women in the U.S. since 2007, when the first cuts started to take effect.
Recently, CMS put forth the Proposed Medicare Physician Fee Schedule Rule for 2012 which calls for a multiple procedure payment reduction (MPPR). The proposed rule applies to the "professional component" of successive diagnostic imaging services administered to the same patient, on the same day, in the same setting. Cuts have typically been applied to the "technical component," or overhead costs of providing exams. The proposal would severely cut reimbursement for physicians, in turn limiting patients' access to diagnostic imaging services. Although opposition to the MPPR rule has been voiced by Rep. Pete Olson (R-Texas) of the House Energy and Commerce Committee and Rep. Jason Altmire (D-Pa.) of the House Small Business Committee, the cuts remain on the table.
While congressional support is critical, medical imaging continues to come under fire. Already this year, the Senate Finance Committee included a proposed $400 million in Medicare cuts to pay for an extension of an unrelated Trade Adjustment Assistance program in a pending free trade agreement with Korea. Fortunately, following outcry from patient groups, industry, and several key policymakers, the cuts were eventually dropped from the bill, but imaging remains on the chopping block in other instances.
In 2006, following the implementation of the Deficit Reduction Act's (DRA), payment rates for advanced imaging services were cut by 19.2 percent (13.3 percent for overall imaging). Similarly, a Government Accountability Office report showed that Medicare cut payments for imaging services by $1.7 billion within one year of DRA's passage.
 These trends cannot continue. Despite imaging's proven value in saving lives and reducing health care costs, these dramatic cuts have already taken a toll on patient access and additional cuts will only further jeopardize access to needed health care. Fortunately, in some instances, members of Congress are rallying behind the medical imaging community.
In a letter to Ways and Means Chairman Dave Camp (R-Mich.), more than 60 Democratic and Republican House members objected to a proposal to cut Medicare reimbursements that would harm patient access to imaging services. Also, in a May House Energy & Commerce Health Subcommittee hearing, Chairman Joe Pitts (R-Pa.) and Ranking Member Frank Pallone (D-N.J.) pointed out that the growth in imaging use in the early 2000s was likely due to advances in technology and patient care, which began to taper off by 2005. The congressmen asked the committee to consider the "complete picture" for medical imaging, including the accreditation and appropriateness policies included in the Medicare Improvements for Patients and Providers Act and the most recent imaging payment reductions in the Affordable Care Act, which won't be implemented fully until 2013.
The reality is that diagnostic services that detect disease earlier deliver value: They save lives and preserve quality of life while preventing higher health care costs over the long term. It is because of imaging that life-threatening health conditions are caught early and Medicare beneficiaries can be treated sooner--preventing the need for longer, more costly treatments due to late-stage diagnosis.
Instead of indiscriminately cutting reimbursement and placing impediments between patients and necessary diagnostic and screening services, the use of evidence-based, physician-developed appropriateness criteria for imaging services should be promoted. Access to life-saving imaging services should not continue to be determined according to a misunderstanding of utilization, on outdated information, or by arbitrary reimbursement reductions.
The medical imaging industry continues to revolutionize health care delivery in America and look toward new ways to innovate and improve health outcomes. To protect seniors, Congress should prevent further reductions to Medicare payments for imaging services and should require a transparent, evidence-based process when setting policy to ensure access to life-saving diagnostic medical imaging services, and ultimately, the right scan at the right time.
Dave Fisher is the executive director of the Medical Imaging & Technology Alliance (MITA). This column is produced in conjunction with MITA, a division of the Association for Electrical & Medical Imaging Manufacturers. MITA is the collective voice of medical imaging and therapy equipment manufacturers, innovators, and product developers. For more information, visit www.medicalimaging.org.
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