Battle Looms Over Funding Cuts for MRIs

Jul 17, 2009

USA Today

As Congress debates a sweeping overhaul of the nation's health care system, a battle is brewing over one provision that could affect the availability of MRIs and other tests, particularly in rural areas.

A coalition of physicians and companies that make medical imaging equipment is lobbying lawmakers to reverse a proposal buried in some versions of health care legislation that would reduce Medicare payments to doctors offering scans in their office.

President Obama and some Democratic lawmakers say the cuts will curtail overuse of MRIs, CT scans and other imaging tests. Opponents counter that some physicians could be forced out of the testing business, reducing access for everyone — including patients with private insurance.

"It's something that's going to affect patients dearly, I'm afraid," said Steven Harms, a radiologist at the Breast Center of Northwest Arkansas.

"There are a lot of small towns (where doctors) are doing CTs and MRIs, and I don't think they're going to be able to stay in business."

Medicare spending on imaging tests in doctor's offices cost $14 billion in 2006, more than double the amount in 2000, according to a Government Accountability Office study. The volume of imaging ordered for Medicare patients in doctor's offices grew 44% between 2002 and 2007, an independent congressional agency found.

Groups lobbying against the change say paying doctors less for performing tests in their office will make the practice unaffordable for some. If they shut down their in-house machines, doctors would send patients to hospitals that, in rural areas, could be miles away, or that, in large cities, could require long waits.

"We're concerned about how it will affect access to care and the availability of those services, particularly in low-income communities," said Jack Lewin, chief executive officer of the American College of Cardiology. "Places that are already on the fringe of saying, 'We can't quite afford this service,' drop off."

Doctors who perform MRIs and other tests in their offices have come under scrutiny in recent years because of financial connections some have to the testing facilities. The arrangement can encourage doctors to order unnecessary tests to increase profits, the Centers for Medicare & Medicaid Services, a government agency, said in 2007.

Lawmakers are seeking ways to pay for a $1 trillion-plus overhaul of health care. Obama wants Congress to vote on a plan before its August recess. Many ideas are in play, including taxes on benefits and a surtax on families earning more than $350,000 a year.

Three House committees began work Thursday on a version of the legislation that would require all Americans to buy insurance and offer subsidies to low-income families to help pay the cost of premiums.

The director of the Congressional Budget Office dealt Democrats a setback Thursday by saying their bill would not decrease costs — a key Obama goal. Instead, the CBO's Douglas Elmendorf told the House the bill "significantly expands the federal responsibility for health care costs." 

Obama stepped up pressure on lawmakers this week to pass a bill. He met at the White House Thursday with Sens. Ben Nelson, D-Neb., and Olympia Snowe, R-Maine, both potential swing votes in the debate.

As the House continues its work, members of the Senate Finance Committee have been meeting in recent days to craft a bill that can win some Republican support.

Eighteen senators, Democrats and Republicans, signed a letter to the Finance Committee this week raising concerns about the imaging issue. Most of them, including Sens. Orrin Hatch, R-Utah, and Mark Begich, D-Alaska, represent rural states.

Health Care for America Now, a group supporting Obama's goal of revamping health care, offered another argument for changing reimbursement rates for doctors: Medicare has a finite amount of money to spend. Imaging competes with other priorities.

"Paying too much for one service may mean paying too little for other Medicare services, such as primary care," spokesman Jacki Schechner said.

Tim Trysla is a lobbyist with Access to Medical Imaging Coalition, a group of medical associations and companies that make imaging equipment. He said Congress and the administration need to further study the impact of the changes. "When someone has delayed health care, that is certainly not good," Trysla said.

AHIP-All Rights Reserved: © AHIP 2008