Senate Passes Medicare Physician Payment, Imaging Criteria Bill
July 10, 2008 - The Senate overcame partisan gridlock on July 9, 2008, and passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) to repeal the 10.6 percent physician payment cut and to test the use of physician-developed Appropriateness Criteria.
The bill repeals the 10.6 percent physician payment cut called for by Medicare's Sustainable Growth Rate (SGR) formula that went into effect July 1. The measure replaces the 10.6 percent cut as well as a 5 percent cut set for Jan. 1, 2009, with a 0.5 percent positive update for the rest of 2008 and a 1.1 percent update through 2009.
The legislation also calls for providers of advanced diagnostic imaging services (MR, CT, PET and nuclear medicine) to be accredited in order to receive payment for the technical component of those services, and establishes a two-year voluntary demonstration program to test the use of physician-developed Appropriateness Criteria.
The physician reimbursement cuts averted by this congressional action are required by the Medicare Sustainable Growth Rate (SGR) formula which dictates that once volume of services reaches a certain threshold, payment for each individual service is decreased to remain within a predetermined spending limit. Such reductions impose an arbitrary payment that does not factor in the cost to physicians of providing services.
"The ACR is gratified that Congress has acted to preserve access to care for our nation's seniors by averting this drastic reimbursement cut and at the same time increasing the quality of those services by enacting quality and safety standards for medical imaging providers," said James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors. "Accreditation, as called for in this legislation, assesses the overall quality of a practice, including personnel, equipment, quality assurance (QA) activities and ultimately the quality of patient care. The imaging provisions in this bill are a major step toward ensuring that beneficiaries receive consistent, quality care nationwide."
Thrall added, "The double-digit cuts that this bill averted may have forced many physicians to limit the number of Medicare patients that they see because reimbursement could have fallen below the cost of providing the exams. The reimbursement updates called for in this legislation will help maintain the ability of physicians to provide high-quality care in the communities in which they serve."
A total tally of 69-30 votes represents the necessary support to override a potential veto by President Bush. Several senators switched their stance from the last time the Senate voted on identical legislation July 26. Intense lobbying and grassroots by the physician community and other stakeholders over the July 4th Congressional recess led to the reversal of the impasse.
The American College of Radiology (ACR) stated that it would "like to thank all members who weighed in with their senators in recent weeks on this very important legislation."
For more information: www.acr.org