The Medical Payment Advisory Commission (MedPAC) plans to release a recommendation calling for a reduction in the use of imaging services, including MRIs, CT scans and nuclear medicine. MedPAC’s advisory opinion would require some physicians and their patients to obtain pre-approval from Medicare for advanced imaging services. The proposal, if implemented without modification, would apply to physicians determined to have higher-than-average rates of inappropriate use of such imaging.
Imaging is one of the fastest-growing Medicare costs, rising from $6.5 billion to $11.7 between 2000 and 2009. CMS believes such restrictions “could add more front-end approaches to better ensure appropriate payments, such as requiring physicians to obtain prior authorization from Medicare before ordering an imaging service.”
Detractors of MedPAC’s recommendations argue that such restrictions on imaging services are premature on account of the regulations enacted in recent years to slow the growth of imaging expenditures. In response to the recommendation, a coalition of imaging manufactures, medical providers and patient groups urged MedPAC to reconsider, warning that implementation of the recommendation would limit access to life-saving diagnostic imaging services, which has the potential to impact the delivery of care to nearly 48 million Medicare beneficiaries.
The MedPAC proposal has also been met by opposition from lawmakers. House Energy and Commerce Health Subcommittee Chairman Joe Pitts, R-Pa., and ranking member Frank Pallone, D-N.J., two Congressman who fought with one another over last year’s health law, joined forces to oppose MedPAC’s recommendation. While Congress is not required to adopt MedPAC recommendations, some Capitol Hill observers believe that Congress may seek to incorporate certain of MedPAC’s proposals, especially in light of the motivation to reduce federal health care expenditures.
For more information on government regulation of imaging services or for professional assistance navigating the ever-evolving healthcare landscape, please contact Carey F. Kalmowitz, Esq. or Adrienne Dresevic, Esq. at (248) 996-8510 or (212) 734-0128, or visit the HLP website.