Coalition Highlights New Study on Impact of Reduced Payments on Screening Use

Washington, D.C. – The Medicare Payment Advisory Commission (MedPAC) must consider the potential downstream impact on beneficiaries’ access and health outcomes when advising Congress about physician payments, the Access to Medical Imaging Coalition (AMIC) said today.  In a letter to MedPAC, AMIC highlighted a new study on dual energy x-ray absorptiometry (DXA) screenings for osteoporosis that illustrates the correlation between inadequate Medicare reimbursement and adverse patient outcomes.

“This study demonstrates the very real impact of Medicare payment cuts on the health and safety of patients, which has been AMIC’s primary concern since the Deficit Reduction Act,” said Tim Trysla, executive director of AMIC.  “Congress and CMS cannot continue to recklessly cut Medicare imaging payments in order to meet short term budget goals without closely examining how it will affect patients’ health over the long term.”

The peer-reviewed study, published in the December 2011 issue of Health Affairs, found that DXA testing in all Medicare Part B settings plateaued in 2007-2009 after the Deficit Reduction Act of 2005 (DRA) and regulations cut Part B imaging payments, following a decade of growth in the use of DXA to detect osteoporosis. According to the study, in those years, 800,000 fewer tests than expected were performed for Medicare beneficiaries—tests that might have prevented 12,000 fractures and their associated health care costs.

“Bottom line, had the rates not been cut, we would not have seen that devastating number of fractures,” said Donna Fiorentino, co-author of the Health Affairs study.  “What’s frustrating is that prevention for this disease is centered around DXA testing.  The screenings are inexpensive, incredibly accurate and great at predicting the disease. We’ve seen all the statistics.  These tests, coupled with appropriate medications, can get people back to the point where their bone is healthy, avoiding unnecessary fractures.”

AMIC members have expressed concern that repeated legislative and regulatory cuts to medical imaging reimbursement since 2006 have led to growing access problems for DXA and other imaging modalities.  In fact, overall per-beneficiary imaging use declined by 2.5 percent in 2010 according to a recent analysis by the Medical Imaging & Technology Alliance (MITA) that was affirmed by MedPAC last month.  While other physician services have continued to grow in volume, medical imaging use has fallen.

Read AMIC’s letter to MedPAC.

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The Access to Medical Imaging Coalition represents more than 100,000 physicians, medical providers, and patient organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of workers. Thus, AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it.

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today applauded the efforts of a bipartisan group of senators, led by Senators John Kerry (D-MA) and Herb Kohl (D-WI), who took a stand to protect patient access to medical imaging in a letter to President Obama.  In the letter, the Senators expressed concern over the impact of deep imaging reimbursement cuts and called on the President to reject further cuts in order to protect seniors’ access to care, preserve American jobs and encourage innovation.

AMIC also commended Senator Robert Casey (D-PA) for spotlighting the negative impact of imaging cuts on jobs in a separate letter to Senate leadership.

“We appreciate the support of Senators Kerry, Kohl, Vitter, Brown, Alexander, Cantwell and Wyden in defending patient access to critical screening and diagnostic services, as well as Senator Casey’s efforts to preserve imaging-related jobs,” said Tim Trysla, executive director of AMIC.  “Recent proposals to implement prior authorization programs and further reduce imaging reimbursements will only exacerbate access issues for Medicare beneficiaries who are already feeling the impact of substantial cuts over the past five years. We hope President Obama and Congress will listen to the call from these Senators to preserve access to these technologies that are critical to disease prevention and detection, and that have turned millions of patients into survivors.”

 Sheila Ross, special counsel to the Lung Cancer Alliance – a member organization of AMIC – and two-time lung cancer survivor, echoed Trysla’s remarks.  “This is a time of great progress in the fight against cancer, in large part due to critical advances in medical imaging technology.  Most recently, new long-term data has established low-dose CT as the first validated screening test that can significantly reduce mortality due to lung cancer, the leading cause of cancer death.  The Lung Cancer Alliance encourages more policymakers to take a stand against additional cuts to medical imaging reimbursement, so that lung cancer patients are not denied access to scans that can save their lives.”

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today said that despite acknowledging that advanced imaging services growth is flat, the Medicare Payment Advisory Commission’s (MedPAC) recommendations to reduce reimbursements for CT, MRI and PET services and impose prior authorization requirements will reduce patients’ access to life-saving diagnostic and therapeutic services.  AMIC called on Congress to reject the recommendations.

“Patients affected by cancers, heart disease and other conditions for which an early diagnosis is critical to their health and survival should take notice that MedPAC is shutting the door on patients and the benefits of medical imaging,” said Tim Trysla, Executive Director of AMIC.  “Even though MedPAC has acknowledged that the most recent Medicare claims data show that advanced imaging spending and volume are flat, they are recommending further cuts to imaging reimbursement and an unprecedented prior authorization program that would, by definition, impede beneficiaries’ access to care.”

Trysla said there is no scientific research validating the clinical quality of radiology benefit managers (RBMs) or whether they truly achieve cost savings or merely shift costs, whereas there are numerous peer-reviewed articles supporting the use of advanced imaging studies.  ”RBMs are not accountable or transparent to the public, and their proprietary algorithms deny or delay care without any peer-reviewed clinical evidence showing they are safe,” said Trysla.

AMIC and several patient advocacy groups recently wrote to MedPAC to oppose the recommendations. (Letter available here.)

A recent study of Medicare claims data by The Moran Company indicates that cuts to medical imaging may already be disrupting seniors’ access to important advanced medical imaging procedures.  From 2008 to 2009, use of advanced medical imaging procedures fell by 0.1 percent, the first decrease in 11 years studied, including volume decreases of 1.2 percent in MRI services, 0.3 percent in screening mammography and 2.2 percent in bone density (DEXA) scans.

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Access to Medical Imaging Coalition (AMIC) Cautions Against Further Threats to Patient Access

Washington, D.C. – The volume of advanced imaging services delivered to Medicare beneficiaries decreased in 2009 for the first time in 11 years, according to a new analysis by The Moran Company.  The study, released today by the Access to Medical Imaging Coalition (AMIC), a coalition of physician, patient and imaging manufacturer groups, found that while the volume of advanced imaging services decreased by .1 percent, the amount of overall imaging services declined by 7.1 percent.

“The analysis found that Medicare spending for advanced imaging services increased by less than half the spending growth for physician services overall,” said Don Moran, president of The Moran Company. “With a 1.2 percent increase in spending for advanced imaging compared with 2.6 percent for services overall, imaging was one of the slowest growing segments of the physician fee schedule in 2009.”

Moran’s analysis of Medicare claims data from 1999 through 2009 examined both the spending and volume of advanced imaging services – specifically CT, MRI and Nuclear Medicine including PET – as well as overall imaging services, including mammography.  The new findings are comparable to a 2008 analysis of Medicare claims data that showed a 19.2 percent reduction in Medicare spending on advanced imaging from 2006 to 2007 and revealed a significantly reduced volume growth rate of only 1.9 percent, which was less than the overall rate of physician-payment growth.

“The decline in volume of critical screening services suggests that access issues are at hand,” said Tim Trysla, executive director of AMIC.  “While imaging has been proven to reduce mortality, additional cuts to Medicare reimbursements threaten to continue the current trajectory and further restrict patient access to life-saving diagnostic tools and screening services.”

The new analysis also found that the total volume of mammography screenings decreased by .3 percent in 2009, compared to a 2.8 percent compound annual growth rate in the past decade. Additionally, the total volume of dual-emission X-ray absorptiometry (DXA), which measures bone mineral density, decreased by 2.2 percent, while spending decreased by 16 percent from 2008-2009.

In the face of this downward trend in imaging use, Congress and government agencies have continued to limit the use of advanced imaging services by cutting Medicare reimbursements and making recommendations that restrict patients’ access to them.  The implication of these policies may include fewer services available for Medicare beneficiaries, longer wait times, and difficulty in diagnosing patients early, when treatment is most effective.

“Advanced imaging is a critical tool for the early detection of disease, which is directly related to beneficial outcomes and extension of lives,” said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors.  “The trend of reduced volume of imaging among Medicare beneficiaries is a concern for doctors who rely on these services to ensure optimal care for their patients.”

Mark F. Victor, MD, vice president of medical affairs for the Cardiology Advocacy Alliance agreed, noting, “Cardiac patients can’t afford lengthy delays in diagnosis and treatment due to limited access to diagnostic imaging tools. It is essential that our policies put our patients first.”

On Monday, President Obama is scheduled to deliver his budget proposal for fiscal year 2012.   As Congress considers spending for the coming year, Trysla said, “We encourage policymakers to consider the value of medical imaging in saving lives and preserving quality of life, while preventing higher health care costs over the long term.”

To view the Moran study executive summary please click here.