VIEWPOINT: Health plan will take toll on access to preventive services
MARK YUHASZ
As prospects grow for passage of health care reform legislation this year, it becomes ever more crucial to examine closely what may be unintended consequences of some of its provisions.
One proposal would enact deep cuts in Medicare reimbursements for medical imaging, forcing imaging centers to scale back their services or even to close entirely. Another proposal would hit device makers with an onerous excise tax that may make it harder for physicians to afford beneficial new technologies and provide a devastating double hit to patient access to imaging care.
One area of general consensus in this reform debate: the need to make preventive services more accessible and affordable.
President Obama himself has spoken about the importance of preventive screenings. Speaking to a joint session of Congress, he said, “There’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.”
The problem is that these short-term, cost-cutting measures that target imaging jeopardize exactly the kind of preventive measures that President Obama and many others support.
At issue in the legislative proposals is the “utilization rate” that Medicare uses as part of their formula to determine reimbursements for diagnostic scans. The current rate is set at 50 percent, meaning – for reimbursement purposes – imaging equipment at a given facility is assumed to be in use 50 percent of the time the facility is open for business. According to a report by the Radiology Business Management Association, that assumption tracks pretty closely with actual utilization at both rural and urban imaging centers across the country.
President Obama has proposed increasing this utilization rate assumption to 95 percent. Some in Congress have proposed a slightly less severe increase, but an increase nonetheless. Under these higher proposed rates, the vast majority of imaging centers will see drastic cuts in their reimbursements from Medicare.
This would have a particularly severe impact on rural populations. According to the Office of Management and Budget, Washington state has 1,063,000 residents living in rural areas. These are the people who will feel the cuts most acutely. Unfortunately, these rural residents are the very people for whom access is already limited.
How exactly will they be impacted? A recent study by the American College of Radiology found that a 25 percent reduction in Medicare payments would force 21 percent of imaging centers to consider closing their doors, and 31 percent to consider scaling back their hours.
This study demonstrates just how unattainable the proposed 95 percent utilization rate is: More than a million Washington residents may be forced to travel long distances, or wait in long lines, as the imaging center currently operating in their area is forced to close or cut hours.
As a radiologist serving Washington state, I see hundreds of cases each year where patients are suffering from diseases and ailments and cannot afford delays in diagnoses, treatments or crucial screenings to monitor their progress.
Washington is already plagued by a significant geographic disparity in terms of health care delivery, measured by comparing mortality rates of each county. The United Health Foundation ranked Washington in the bottom 20 in this category. Our state’s rural population simply cannot afford policy decisions that put them at an even greater health disadvantage to other parts of the state.
Potentially more devastating, there is another proposal in some versions of health care reform legislation that would threaten imaging services. Some in Congress are proposing to levy a hefty tax on medical device and diagnostic products – another hit to imaging that would greatly stifle medical innovation and limit patient access to life-saving diagnostic scans.
These proposed cuts are piled on top of Medicare cuts already made to medical imaging reimbursement as part of the Deficit Reduction Act of 2005 (DRA) – cuts that are impacting the availability of imaging services, especially in rural practices.
According to the Government Accountability Office (GAO), in 2007 alone, $1.64 billion was cut in reimbursements for advanced imaging services, such as CT scans and MRIs that so many seniors rely on for early diagnosis and effective treatment of disease.
Every patient whose life has been saved by medical imaging can attest to the incredible value medical imaging offers and justify not only its costs, but its necessity. Numerous patients have spoken about the incredible impact medical imaging has had on their lives and the effectiveness of their treatments.
As a doctor, my primary concern is with the diagnosis and treatment of my patients and providing them with the best possible course of action to bring about the best possible outcomes. Medical imaging is often a key part of ensuring patients receive proper diagnosis and the top-notch level of care they deserve.
Severely limited access to life-saving advanced imaging technology – in particular for Medicare beneficiaries – would be an unintended and unfortunate consequence of current reform efforts. I urge lawmakers to seriously consider these consequences before including drastic funding cuts and levying onerous excise taxes.
Dr. Mark Yuhasz of TRA Medical Imaging lives in Gig Harbor.
