Why Payment Policy Matters

The following post was contributed by Geraldine McGinty, MD, MBA, FACR. (Adapted from opening remarks at the ACR 2015™ Economics Forum)

One of the more attended sessions at the recent ACR 2015 meeting was the Economics Forum. I am sure that, for many, this session was an eye-opening experience – in terms of the challenges we face and the mountain of work the ACR Economics Commission and staff does for members.

But this Commission is all of you. We can’t do what we do without your support.

Yes. This work is sometimes frustrating. We sometimes feel payers are making poor decisions. We think that there are things that don’t make sense. But we do have to keep working at it.

Why do we keep working at it? We do it because payment policy matters. An achievement like lung cancer screening, where CMS decides to cover a new imaging program, happens because we started with valid scientific evidence, we went through a collaborative process with other stakeholders and we set out a robust quality program. Despite many obstacles, CMS ultimately approved Medicare coverage. This coverage enables patients who need this care to have access to it. This, in turn, save lives.

Payment policy also matters because bad coverage decisions can cost lives. An example of this is – if we see payment policy changes to breast cancer screening due to recent U.S. Preventive Services Task Force draft recommendations. Despite our best efforts, this could result in thousands of unnecessary breast cancer deaths each year.

So payment policy matters, and that is why we devote so much time and effort to its tasks. We have an obligation to our patients to get this right. We simply have to get this right.

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