A Roller Coaster Week

It’s been a roller coaster week for our government relations team as the Sustainable Growth Rate reform bill has hung in the balance and with it our game changing proposal to implement collaborative educational decision support for our referring provider colleagues when they order advanced imaging. As we bite our nails and hope that the Congress can get at least a temporary patch implemented (again) with our clinical decision support program included I have to recognize the dedicated team that is our interface with the legislative branch. These folks know everyone there is to know on The Hill and they could not be more passionate about advocating on our behalf for the value that we deliver to our patients. We are lucky to have them on our team.

One of the provisions in the current version of the legislation about which we are extremely concerned gives the secretary of Health and Human Services (HHS) much broader authority to set payments and values for the services we provide. The RUC, an independent AMA committee on which I sit as the ACR’s representative and which currently derives the valuations recommendations that are sent to Medicare, seems to be threatened with irrelevance by this provision. Now the RUC is not perfect, but it still represents the best efforts of expert physicians from all the major specialties and its recommendations are developed from survey data for physicians who actually perform the services being provided. I don’t know that having the secretary and HHS decide on valuations could possibly have the same credibility.

The news changes daily, but here’s hoping that good sense wins out because what radiologists are bringing to the health care reform table is exactly what the doctor ordered and I am really proud of our specialty’s leadership and vision.

Author – Geraldine B. McGinty, M.D., MBA, FACR

The Poison Pill

Last week, the House of Representatives passed a Sustainable Growth Rate (SGR) reform bill. Within the bill were items that were important to ACR and radiology including Clinical Decision Support (CDS) and Multiple Procedure Payment Reduction (MPPR). Radiology was the only specialty to get specific provisions into SGR reform. It was a milestone for radiology and medicine that we saw a legislative body recognize the need to address the flawed SGR formula.

The problem is that to pay for the bill, it was attached to a provision that would suspend for five years the penalties associated with the individual mandate, which is a core component of the Affordable Care Act. The democratic majority in the Senate would not consider such legislation. The president would never sign it. On the other side of the Capitol, the Senate is considering the same legislation but is either not identifying how they intend to pay the $180 billion price or will use unspent funds from our involvement in oversees wars. The Republicans in neither the House nor Senate will support this funding method.

As a result, a much needed piece of legislation is being held hostage by the politics of the midterm elections.

We will probably see another “Doc Fix” patch for nine months that takes us past the November elections. There is every indication that permanent SGR reform will be considered after the election season.  The good news is that the ACR and radiology will be striving to maintain if not strengthen the language in whatever bill emerges from the vantage of already establishing the high ground.

While momentum in Washington can be fickle, at least this time it is on our side.

As always the ACR government relations team values your support.

Author – Howard B. Fleishon, M.D., MMM, FACR

A Brief Survey…

When I’m on the phone with my bank and I get the message asking me to take a short survey at the end of the call I almost never say yes. We are all so busy; finding the time to do anything other than what we have already on our plate is a challenge. Soon, many of you will be receiving emails from the ACR asking you to complete a survey. I’ll be perfectly honest: it’s neither short, nor particularly easy. What it is, however, is vitally important.

These surveys are fundamental building blocks in the process for assigning value to the services we provide as radiologists. Imaging services are scrutinized by the AMA’s Relative Value Update Committee (RUC) and recommendations for how they should be valued are submitted to CMS for final approval. These values (measured in Relative Value Units (RVUs) are used to determine payments in the Medicare Physician Fee Schedule. These same RVUs are also used by many commercial insurance payers. Your team at the RUC, led by Dr. Zeke Silva, uses your survey data to develop their presentation to the RUC. Without your input they cannot make an effective case for appropriately valuing the work we all do.

The survey template is set by the RUC. While rather arcane, it is the same for everyone. Your patience is appreciated.

If you have questions about the process you can contact Stephanie Le at sle@acr.org, but please don’t delete that email. The ACR cannot advocate effectively without your response.

Author – Economics Committee on Reimbursement Member, Kurt Schoppe, M.D.