[Congressional Record Volume 154, Number 124 (Saturday, July 26, 2008)]
[Senate]
[Page S7531]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY:
  S. 3343. A bill to amend title XVIII of the Social Security Act to 
provide for a disclosure requirement under the Medicare program for 
physicians referring for imaging services; to the Committee on Finance.
  Mr. GRASSLEY. Mr. President, I am pleased today to introduce the 
Medicare Imaging Disclosure Sunshine Act of 2008.
  I agreed to a short-term Medicare extension bill last December with 
the understanding that this would give us the opportunity to include 
other priorities in a bipartisan Medicare package this year. One of the 
significant issues I had hoped to address was the lack of transparency 
in physician self-referrals for imaging services in the Medicare 
program.
  The recently-enacted Medicare bill requires accreditation for 
providers of the technical component of advanced diagnostic imaging 
services such as magnetic resonance imaging, MRI, computed tomography, 
CT, scans, and positron emission tomography, PET, and it establishes a 
demonstration project to assess appropriate physician use of these 
services. However, Mr. President, the legislation regrettably fails to 
address an issue that has contributed significantly to the rapid growth 
in Medicare spending for imaging services: physician self-referrals for 
imaging services in their offices and in facilities where they own or 
lease advanced imaging equipment. According to a June 2008 report of 
the Government Accountability Office, Medicare Part B spending for 
imaging services more than doubled in 6 years, growing from $6.89 
billion in 2000 to $14.11 billion in 2006. During this time, the 
percentage of Medicare spending on imaging services provided in 
physician offices grew from 58 percent, about $4 billion, in 2000 to 64 
percent, about $9 billion, in 2006. Spending on advanced imaging 
services, such as MRIs, CT scans, and nuclear medicine, also grew 
substantially faster than other imaging services.
  Beneficiaries need more transparency and disclosure of potential 
conflicts of interest when physicians write referrals for imaging 
services. An imaging disclosure provision was included in the Medicare 
bill that I introduced in June, and it was included in the agreement 
that Senator Baucus and I reached for this year's Medicare bill. The 
provision was not onerous nor was it overly proscriptive: it merely 
required referring physicians to disclose any conflict of interest 
related to their ownership of advanced imaging facilities or equipment. 
Patients still would be free to choose their physicians' imaging 
facility or equipment or to go elsewhere. Unfortunately, the imaging 
disclosure provision was dropped from the Medicare bill that Congress 
enacted once the process became partisan.
  It is for this reason that I am introducing this bill. The Medicare 
Imaging Disclosure Sunshine Act does just what the name implies: it 
requires referring physicians to shed some light on their relationship 
to imaging facilities and equipment they own by disclosing that 
ownership interest and providing beneficiaries with a list of 
alternative providers. The referring physician is required to inform 
the individual in writing at the time of referral that he or she can 
obtain imaging services elsewhere if they choose to do so and to 
provide a list of imaging suppliers located where the individual 
resides. The imaging services covered by the requirement include MRIs, 
CT scans, PET, and other radiology services specified as designated 
health services that the Secretary of Health and Human Services 
determines appropriate. The requirement would be effective in January 
2010.
  Technology has made great advances in imaging services in recent 
years, and improvements in imaging hold much promise for earlier and 
more accurate diagnoses of life-threatening diseases which often may 
lead to improved outcomes for patients. But we must do more to help 
control the potential for overutilization of imaging services. The 
Medicare Payment Advisory Commission, or MedPAC, and others have 
expressed serious concerns that the sizeable growth in the volume of 
imaging services needs to be addressed. In March 2005, MedPAC 
recommended that the Secretary of HHS establish standards for providers 
of diagnostic imaging services and measure physicians' use of imaging 
services with their peers. Those recommendations were addressed to some 
degree in the Medicare bill that Congress enacted. However, another key 
MedPAC recommendation--that the Secretary of HHS strengthen the rules 
limiting physicians' financial incentives to order imaging services--
unfortunately was ignored.
  The June 2008 GAO Report noted that physicians in specialties other 
than radiology generated an increasing share of revenue from in-office 
imaging services from 2000 to 2006. They also found that in-office 
imaging spending per beneficiary, like other Medicare spending, varied 
widely across geographic regions of the country. By 2006, in-office 
imaging spending per beneficiary varied from $62 in Vermont to $472 in 
Florida, nearly eight times as much. This raises additional concerns 
about overuse since research on geographic variations on health care 
spending shows that, generally, providing more services does not lead 
to improved health care outcomes. In GAO's view, the shift in imaging 
services from hospital settings to physician offices has the potential 
to encourage overuse in light of the financial incentives that exist 
for physicians to supplement lower professional fees for interpreting 
imaging tests with relatively higher fees for performing the tests. 
They concluded that physician ownership of imaging equipment is a way 
to generate additional revenue for a practice.
  The Medicare Imaging Disclosure Sunshine Act will provide another 
necessary tool to address the significant increase in Medicare spending 
for in-office imaging services by providing more transparency and 
shedding some light on physician referrals to facilities and medical 
imaging equipment they own. I urge my colleagues to support this 
legislation.
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