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Health hazard? Proposed cutbacks in MRI scans stir up opposition

mri120909_optOcean County patients, physicians, advocacy groups and community leaders said that steep Medicare cuts proposed by Congress, as well as the Obama Administration, threaten patient access to diagnostic imaging services — in particular for our nation's seniors.

Since payment rates for Tricare, the health care system for veterans, are linked to Medicare rates, our nation's veterans and their families also risk losing access to diagnostic services in non-hospital settings.

In Ocean County — where residents suffer from the third highest cancer incidence rate in New Jersey — doctors will soon be forced to scale back or discontinue medical imaging services, due to the major reimbursement cuts recently released in the Centers for Medicare & Medicaid Services' (CMS) 2010 Physician Fee Schedule.

At the same time, Congress is proposing policies that would reduce physician payments for imaging services, as well as a tax on medical devices including imaging equipment, all of which could inhibit patients' access to early disease detection and possibly turn back the clock on the war against cancer and other serious diseases.

"It's very important that all patients have access to the medical imaging they need," said Marge Medeiros, a Medicare beneficiary and patient of Ocean Medical Imaging. "A lot of patients rely on medical imaging to properly monitor various health conditions, particularly seniors. We need to be assured that we will continue to have access to high quality medical care, and medical imaging is of course a very important part of that care."

The annual tax on medical devices proposed in the House and Senate health reform bills has the potential to inflict serious, systemic and long-term harm on the quality of American health care, as it will stifle the innovation of new imaging and cutting edge cancer-therapy technologies that can detect disease earlier and personalize disease treatment, while preserving quality of life and delivering better outcomes with less radiation.

"Medical imaging is an essential technology that should be available to Americans without being cost prohibitive. Cutting reimbursements and additionally levying an excise tax on its use is detrimental to quality healthcare in this country," said Assemblyman David C. Russo (R-Bergen).

Dr. Joseph Triolo, a radiologist with Ocean Medical Imaging in Toms River, called on the New Jersey Congressional Delegation to reject both the tax and the proposals that would reduce payment rates for diagnostic imaging.

"In 2006, Congress made significant cuts to medical imaging reimbursement, and the impact of those cuts are just beginning to be felt - especially in smaller communities," said Dr. Triolo, referring to the imaging payment cuts made by the Deficit Reduction Act of 2005, which reduced Medicare spending on advanced imaging by 19.2 percent in the first year alone. Triolo added, "Further cuts could decimate imaging services in the community, placing significant burdens on patients trying to access the diagnostic services they need. Already, patients from our surrounding communities are often forced to travel long distances to receive vital services, including mammograms. The combination of further deep cuts and a devastating new tax would force physicians to pull back services in their communities and forego upgrading to more effective equipment."

Data collected by the Radiology Business Management Association (RBMA) and the American College of Radiology (ACR) appears to underscore this concern. According to their recent survey, if proposed reimbursement cuts are made:

  • 36 percent of practices would consider limiting access to Medicare beneficiaries
  • 25 percent would consider dropping out of the Medicare program
  • 40 percent would consider consolidating service sites
  • 40 percent would consider closing their center

"Another deep cut in reimbursements for diagnostic imaging will not only further curtail access to MRI and CT, but it will have the unintended consequences of curtailing access to all medical imaging as centers are forced to close their doors or cut back on their hours of operation," said Dr. Pandur Miskin, a neurologist from Brick. "CMS' rule represents the most dramatic aggregate cut of any healthcare provider class within the Medicare program over the same period of time and will devastate access to appropriate imaging."

— ANDY LAGOMARSINO, NEWJERSEYNEWSROOM.COM

 
Comments (3)
3 Monday, 21 December 2009 21:04
Larry Smith
The implications of imaging cuts have been getting little attention in the health care reform debate. Although almost everyone knows about the 5% tax on cosmetic procedures (or lack thereof), almost no one knows about the drastic cuts in imaging and the consequences this could have on patients nationwide.

In addition, almost everyone has heard about the dangers of radiation from radiological procedures, but no one has heard about the benefits radiology has had on millions of patients. There is countless data demonstrating how effective radiology has been in early disease diagnosis, monitoring cancer treatment, changing/guiding medical management, etc, but that never makes the press. This is exactly why people who know the benefits of radiology and follow the health care debate are outraged.

No one denies that radiology is over-utilized nationwide. But the way to address this is notto reduce reimbursements all together which could have detrimental effects on patient access. Rather, Congress must get to the sources of the problem which include: 1) self-referral by physicians (non-radiologist physicians mostly) who have a clear financial incentive to order as many studies as possible on their patients, and 2) applying appropriateness criteria (as outlined by the American College of Radiology) in ordering studies so that ordering physicians can have guidance in applying the most effective and safest study for their patient.

Instead, the media and un-read physicians focus on arguments such as the dangers of CT radiation. Indeed, CT has a lot of radiation and has the potential to cause harm. But what people (including the above poster) have to recognize is that these studies (like ALL studies) have to be read with a critical eye. Just because an article is published in the New England Journal of Medicine or Archives of Internal Medicine doesn't mean that it's without it's flaws. For example, these studies use data from atomic bomb survivors form Japan and make the assumption that this same data can be used to those exposed to radiation from diagnostic studies. These studies also assume that those patients getting CT scans are of the same health as those in the general population. Lastly, almost all these studies that outline the almost certainly overstated risks of diagnostic radiation acknowledge that there is no evidence and no identifiable case that radiologic studies ever caused a cancer. Ever.

It's one thing to acknowledge the problems of overutilization and radiation dose, but to sensationalize an unproven risk that overshadows the proven benefits of radiology is unfortunate. The debate must be more balanced. More attention needs to be put on the benefits of radiology and on the dangers of taking radiology away as Congress is planning to do.
2 Sunday, 20 December 2009 11:31
Hank Koche
This is out of context for instance, the most sick among us get scanned more. But you should read the WSJ; look up an article from last August "the Rationer In Cheif" and the recommendations of the United States Preventive Services Task Force to limit mammography tests for women under 50 or over 70?

Under health reform and this administration's efforst to cut spending there will be much less access to care and more expenses.

The United States of America is the best place in the world treating cancer. This is because we get knowledge early, we test. We may not do diabetes or obesity well, but early detection and treatment of cancer tumors, YOU BETCHA.

Most of us will be okay with this Health Reform and the reduced access to testing, but good help you if you get sick. There are grave consequences looming to these choices.
1 Tuesday, 15 December 2009 11:48
Chris Barker
Wow Mr. Lagomarsino, is this a press release or a news story? Are you paid by the imaging lobby or newjerseynewsroom.com? Did you know your story is prominently placed in the "news" section at rightscanrighttime.org, an imaging industry trade group? It's not surprising given its lack of balance.

The part about "stifling innovation" and "delivering better outcomes with less radiation" is downright disturbing, particularly in light of a a recent National Cancer Institute report that said 29,000 cancers - and 14,500 deaths - related to radiation exposure from CT tests will occur in people who were scanned just in the year 2007.

You should know your reporting could be hurting people. How about an article detailing the risks of CT scans to provide some balance to your readers? Imaging can help but medical researchers are quickly discovering it's vastly overused, particularly for heart disease and musculoskeletal disorders. Not only can the radiation harm you, it can lead people to get unnecessary surgeries that carry the risk of harming them for life.

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