Transcript Slide 1

Federal and State Legislative Update
Alabama Academy of Radiology Meeting
March 5, 2005
Ariel González, MA - ACR State Legislative Specialist
ACR Government Relations
Focus of today’s discussion
• Brief Washington Office Update
• ACR efforts during the 108th Congress
• ACR legislative priorities for the 109th Congress
• Success of RADPAC
• ACR state legislative initiatives
ACR Government Relations
Staff Changes and Additions
 Ted
Burnes, Director of RADPAC
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Former State Legislative Specialist
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MA in Government Relations from GWU
 Gloria
Romanelli, Director of Federal Affairs
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Arizona State University Law Graduate
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Former staff member for Rep. Terry Bruce (IL)
ACR Government Relations
Staff Changes and Additions
 Ariel
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Gonzalez, State Legislative Specialist
Second year law student, Catholic University
MA in Legislative Affairs from GWU
 Jay
Greissing, Assistant Director,
Congressional Relations
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Fordham University School of Law Graduate
Former Counsel on United States Senate
Committee on the Judiciary (Republican Staff)
ACR Government Relations
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New Government Relations Office
1701 Pennsylvania Ave
One block from the White House
Quicker access to Capitol Hill
Fundraisers
ACR Government Relations
• ACR Accomplishments in the 108th Congress
– Medicare / prescription drug reform legislation
– Comprehensive prescription RX package averted 4.4%
decrease in Medicare CF in ’04
– 1.5% increase in CF for ’04 and ’05 additional
reimbursement
– Reimbursement increases for M.D.s in rural areas
– Increased reimbursement for certain mammography
procedures
ACR Government Relations
• 108th Congress Legislative Highlights
– MQSA Reauthorization
– Medical Liability Reform Votes
ACR Government Relations
• 109th Congress Legislative Priorities
– Inappropriate Utilization of Diagnostic Imaging
– Medicare Physician Payment Policy
• Link payment for performance and interpretation of CT,
MRI, and PET studies to satisfaction of quality and safety
standards.
• Sustainable Growth Rate (SGR)
– Medical Liability Reform
– Lessen the Regulatory Burden of MQSA
ACR Government Relations
• Inappropriate Utilization of Diagnostic Medical
Imaging
– The ACR has discussed this issue with Congress,
federal agencies, medical specialty societies, and
businesses
– MedPAC recommendations
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• Inappropriate Utilization of Diagnostic Medical
Imaging
– Meeting discussions
• The Administration has tasked Congress with
implementing initiatives that will reduce the federal
budget deficit
• Potential savings in Medicare, especially imaging
• Amending the Stark law to close the loophole for in-office
ancillary services is a political and logistical impossibility
• The future of healthcare services is a “pay for
performance” paradigm with emphasis on quality and
safety linked to reimbursement
ACR Government Relations
• Inappropriate Utilization of Diagnostic Medical
Imaging
– Meeting discussion (cont’d)
• Imaging is the fastest growing type of medical
expenditure within the category of physician
services in the United States
• Technological advances led to imaging equipment
at reduced size and cost encouraging a shift in site
of service from hospitals to physician offices
• Non-radiologist physicians are performing and
interpreting an appreciably growing portion of
images produced in CT, MRI, and PET studies
ACR Government Relations
• Inappropriate Utilization of Diagnostic Medical
Imaging
– Meeting Result: Congress
• Bipartisan acknowledgement of the need to reduce over
utilization of imaging services
• There will be cuts in Medicare during 109th Congress
• Interested in MedPAC recommendations to improve
quality and safety.
• Interested in Medicare savings that ACR’s policy may
bring – a conservative estimate of nearly $6 billion over
10 years
• Bipartisan agreement that pursuing solution that would
close the in-office ancillary services exception to the Stark
law is not viable
ACR Government Relations
• Inappropriate Utilization of Diagnostic
Medical Imaging
– Meeting Result: Agencies
• OMB
– Favors ACR policy over Stark approach
– Impressed with ACR’s estimated savings and wants
to share with CBO.
• MedPAC
– Will not consider Stark approach
– Published recommendations in its March 2005 report
for Medicare physician payment policy for diagnostic
medical imaging services
ACR Government Relations
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Inappropriate Utilization of Diagnostic
Medical Imaging
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MedPAC recommendations of chief importance
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“The Congress should direct the Secretary to set standards
for all providers who bill Medicare for performing
diagnostic imaging services. The Secretary should select
private organizations to administer the standards.”
“The Congress should direct the Secretary to develop
standards for physicians who bill Medicare for interpreting
diagnostic imaging studies. The Secretary should select
private organizations to administer the standards.”
ACR Government Relations
• Inappropriate Utilization of Diagnostic
Medical Imaging
– ACR Policy – “Diagnostic Medical Imaging
Provider”
• Certification by the Secretary of HHS is
required for lawful operation of all facilities
providing CT, MRI, and PET
• In order to be certified, a facility must be
accredited by a private, non-profit organization
with experience in diagnostic medical imaging
accreditation, including the ACR
• A facility seeking accreditation must satisfy
certain quality standards.
ACR Government Relations
• Inappropriate Utilization of Diagnostic Medical
Imaging
– ACR Policy – “Diagnostic Medical Imaging Provider” (cont’d)
• Medicare payment for CT, MRI, and PET studies shall
only be made for the professional component of the
services if the physician interpreting the clinical image
produced by such study is a qualified interpreting
physician, and shall only be made for the technical
component if the facility conducting the study is a
certified facility.
• Qualified interpreting physician is a radiologist or other
licensed physician who interprets clinical images
produced in CT, MRI, or PET studies and who meets the
appropriate education, training, and experience
requirements established by the Secretary in
consultation with the ACR.
ACR Government Relations
• Inappropriate Utilization of Diagnostic
Medical Imaging
– MEDIC – The Medical Excellence in Diagnostic
Imaging Coalition will work to give this issue
mainstream credibility by focusing on the
importance of quality and safety in imaging
• Seeking allies in other specialties, private
insurance companies, manufacturers, and
corporations.
ACR Government Relations
• Medicare Physician Fee Payments
– National fee schedule and spending target implemented in
1992 to address issues of affordability and Medicare
program sustainability by slowing spending growth.
– Sustainable Growth Rate (“SGR”)
– In 2003, Medicare spending for physician services totaled
nearly $48 billion, which accounted for about 1/6 of program
spending overall. October 2004 GAO Report.
– Technological advances in areas such as diagnostic medical
imaging services will increase the price tag of Medicare
program that is already unstable.
ACR Government Relations
• Medicare Physician Fee Payments (cont’d)
– SGR system targets are designed to allow spending per
beneficiary (adjusted for the estimated underlying cost of
providing physician services) to grow at the same rate as the
national economy grows over time on a per capita basis.
• Target = annual increase is set equal to the estimated
change on physicians’ cost of providing services
• High growth in volume and intensity of services causing
spending to exceed the SGR target = future fee updates
are set below the estimated increase in physicians’
average cost
– if the gap b/w spending and the target is wide
enough, the SGR results in fee reductions
• Low growth in volume and intensity of services causing
spending to fall below target = fee increases
ACR Government Relations
• Medicare Physician Fee Payments (cont’d)
– In 2002, physician fees reduced by 5.4%
– While administrative and legislative action have
overridden the SGR for 2003–2005, physician
fees are expected to fall by approximately 5%
each year from 2006 until 2012.
• Future reduction attempts to offset previous
excess spending
• Discourages physicians from treating Medicare
beneficiaries.
– Congress will consider appropriateness of current
spending targets and the SGR as a system for
determining physician fee updates.
ACR Government Relations
• Medicare Physician Fee Payments (cont’d)
– SGR Reform
• End the use of spending targets and separate fee
updates from explicit efforts to moderate spending
growth
– MedPAC favors this and also recommends Medicare seek
to control spending growth by identifying and addressing
the rapid proliferation of diagnostic medical imaging
utilization.
• Retain spending targets but modify the current SGR
system to address perceived shortcomings.
– AMA wants prescription drugs taken out of the formula –
CMS can do this through the rulemaking process without
Congressional mandate.
ACR Government Relations
Medical Liability Reform
– The Liability Crisis
• Even injured parties with meritorious claims receive less than 50
cents on the dollar – Tillinghast-Towers Perrin.
• Medical liability costs add $60 billion to $108 billion to the costs
of health care each year, diverting scares health care resources
to the legal system and away from direct patient medical care,
research and quality – Dept. of Health and Human Service.
• Alabama is a “problem signs” state – American Medical Assn’
ACR Government Relations
Medical Liability Reform (cont’d)
– Effect on Radiologists
• Most frequent defendants in medical liability actions because of
joint and several liability.
• Misdiagnosed breast cancer – most common cause of medical
liability claims.
– Effect on patients
• Fewer residents pursuing fellowships in breast imaging.
• Women losing access.
ACR Government Relations
Medical Liability Reform (cont’d)
– Cost savings if comprehensive reform legislation is signed into
law:
• $14.9 billion in federal spending over the next 10 years for
Medicare, Medicaid, and Federal Employees Health Benefits
Program. $6 billion in State and local government spending,
including $2.5 billion for Medicaid – Congressional Budget
Office.
• $16.7 billion in federal spending on health care system over
the next 10 years b/c of reducing costs associated with
defensive medicine – Joint Economic Committee.
ACR Government Relations
• Medical Liability Reform (cont’d)
– 109th Congress - Republican Leadership continues
to consider the MICRA approach:
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Limiting Non-Economic Damages
Limiting Punitive Damages
Proportionate Liability
Collateral Source Reform
Limiting Attorney Contingency Fees
Federal Statute of Limitation
Periodic Payment of Damages
ACR Government Relations
• Medical Liability Reform (cont’d)
– 109th Congress - Likely alternative
initiatives to the MICRA approach:
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McCarran-Fergusson Reform
Medical Tribunal
Certificate of Merit
Qualified Medical Specialist
Mediation
ACR Government Relations
Medical Liability Reform (cont’d)
– 109th Congress: Leading Legislation
• H.R. 534 (Cox) – introduced on Feb. 2, 2005
• S. 354 (Gregg/Ensign) – introduced on Feb. 10,
2005 (comprehensive reform)
• S. 366 (Gregg/Ensign) – introduced on Feb. 10
(OB/GYN)
• S. 367 (Gregg/Ensign) – introduced on Feb. 10
(OB/GYNs and trauma surgeons)
ACR Government Relations
• Medical Liability Reform (cont’d)
– 109th Congress: Congressional Realties for the MICRA
Approach
• Senate procedure – 60 votes required to block a filibuster
and vote on a piece of legislation.
– Because there are 55 Republicans in office, more potential
to negotiate around a filibuster of the MICRA approach.
– However, some Republicans, including Shelby and
Graham, will only support caps on non-economic damages
if there is a carve out for catastrophic injuries, and do not
want to limit attorney contingency fees.
ACR Government Relations
• MQSA
– 108th Congress
• H.R. 4555 (Rep. Dingell)
– Signed into law by President Bush on October 25, 2004 –
Public Law No: 108-365
– Reauthorized for 2 years – until 2007
– 2 industry reps on NMQAAC
– 109th Congress
• IOM and GAO Reports in 2005
• Reauthorization for 2007
ACR Government Relations
RADPAC
• Third largest medical specialty PAC
• Have contributed over $1 million to congressional and senatorial
campaigns during the 2002-2004 election cycle.
• 89% of candidates supported were victorious in November 2002
elections.
• Valuable lobbying tool to increase radiology’s visibility on Capitol Hill
• For info go to www.radpac.org
ACR Government Relations
RADPAC (cont’d)
• Alabama federal candidates supported by RADPAC:
– Jo Bonner, Alabama 1st (Republican) (on Budget
Committee)
– Robert “Bud” Cramer, Alabama 5th (Democrat)
(not on Committee of Jurisdiction but voted YES
on H.R. Medical Liability Reform)
ACR Government Relations
• State Government Relations
– The ACR offers assistance on a variety of state
legislative issues of importance to our members
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Physician Self-Referral
Certificate of Need Laws
Telemedicine Licensure
Radiologist Assistant legislation
State medical liability laws
ACR Government Relations
• State Government Relations – effort to analyze
inappropriate utilization of imaging services
• Request for Proposal
• Crowell and Moring Project
– Phase I – State Self-Referral Laws
– Phase II – Certificate of Need Laws
ACR Government Relations
• State Government Relations (cont’d)
Inappropriate Utilization, varying solutions and challenges by state
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Maryland example
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MD Health Occupations Code 1-301 (k) (2) provides:
– Except for a Radiologist group or office consisting solely of one or
more radiologists, “in-office ancillary services” does not include:
• (i) Magnetic resonance imaging services
• (ii) Radiation therapy services; or
• (iii) Computer tomography scan services
ACR Government Relations
• State Government Relations (cont’d)
Maryland Law
• Maryland law bars a physician in any non-radiology group
practice from self-referring patients regardless of who performs
the tests.
• Resulted in Maryland non-radiology groups trying to overturn in
legislature.
• MRS is aware and countering.
ACR Government Relations
• State Government Relations (cont’d)
Maryland has its first enforcement case
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The case involves a neurologist self-referring for MRI scans to a facility
in which he has a significant financial interest.
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If found in violation of the Maryland Health Code, the Board may
impose sanctions against the doctor’s license including revocation,
suspension, reprimand, or may place the physician on probation and/or
may impose a monetary fine pursuant to the Maryland State Health
Code.
ACR Government Relations
The issue manifests across the nation
California – proposing “Maryland” legislation AB 516 (2/16/05)
“except for a radiologist group practice or an
office consisting solely of one or more
radiologists, the prohibition of Section 650.01
shall apply to magnetic resonance imaging
services, computed axial tomography
services, or positron emission tomography
performed within a licensee's office, or the
office of a group practice”
ACR Government Relations
• South Carolina
– Proposed imaging center with 49 percent physician
interest; 51 percent hospital
• Texas
• Indiana
• Rhode Island pursuing a Maryland style approach
ACR Government Relations
• State Government Relations (cont’d)
• Phase II of the Project – state by state CON Analysis
– The analysis breaks down states by “No Certificate of Need
Law”, “Limited Certificate of Need Coverage” and
“Comprehensive Certificate of Need Laws” (Alabama is one
of these states).
– Members may access this information by contacting Ariel
González at (703) 715-3488 or at [email protected]
– A summary chart will also be available on www.acr.org under
“Advocacy” and State Government Relations
ACR Government Relations
In Closing…
• Grassroots Activity
– “All politics is local.”
– ACR has a great legislative and regulatory
team in Washington
– The team depends on the involvement of
physician leaders
ACR Government Relations
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Get involved in the process
Local, state or federal level
Volunteer
Attend/host fundraisers
Meet with your lawmaker
ACR Government Relations
Thank You!
Questions or Comments?