[Congressional Record (Bound Edition), Volume 158 (2012), Part 5]
[Senate]
[Pages 6012-6013]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      DIAGNOSTIC IMAGING SERVICES

  Mr. CARDIN. Madam President, I have introduced the Diagnostic Imaging 
Services Access Protection Act of 2012, joined by my colleague from 
Louisiana, Senator David Vitter. Our goal is to preserve Medicare 
beneficiaries' access to life-saving advanced diagnostic imaging 
services, such as magnetic resonance imaging, MRI, computed tomography, 
CT, and ultrasound.
  Let me explain why this legislation is necessary. Medicare 
reimbursement for radiology services is based on two components: 
technical and professional. The technical component comprises the cost 
of equipment, nonphysician personnel, and medical supplies associated 
with the imaging process. The professional component is calculated by 
factoring in the radiologist's time, effort, and skill involved in 
interpreting images, rendering patient

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diagnoses, and reporting the findings in the patient's medical record. 
In recent years, the Centers for Medicare and Medicaid Services sought 
to control imaging growth by cutting reimbursement for the technical 
component--reducing payment for multiple imaging services administered 
by the same physician to the same patient during a single office visit. 
This policy is referred to as the multiple procedure payment reduction, 
or MPPR. It is designed to take into account the efficiencies achieved 
by doing same-day procedures on the same patient, and for the technical 
component of radiology, it makes sense.
  However this year, CMS decided to apply the MPPR to the professional 
component as well. The 2012 fee schedule rule, which took effect on 
January 1, cut the professional component reimbursement for 
radiologists by 25 percent for additional images. This payment 
reduction ignores the realities of medical practice. It is not 
supported by sound data, nor was it developed with meaningful physician 
input. Because each imaging study produces its own set of images that 
require individual interpretation, radiologists are ethically and 
professionally obligated to expend the same amount of time and effort 
interpreting each one, regardless of the number of images, the section 
of the body being examined, or the date of service.
  Further, because radiologists are referral-based physicians who 
rarely order the studies they interpret, MPPR is an ineffective tool to 
reduce inappropriate utilization. Beneficiaries receiving multiple 
imaging studies often represent the sickest and most complex cases. 
They may have advanced cancer or be recovering from a stroke, serious 
car accidents, multiple gunshot wounds, or other forms of deadly 
trauma.
  Not only will CMS' flawed policy disproportionately affect the most 
vulnerable patients, it may also create incentives to shift services 
away from the private practice setting, where the physician fee 
schedule applies, to the more expensive hospital outpatient setting.
  Our legislation will ensure that CMS does not arbitrarily undervalue 
the role of the radiologist within the health care delivery system. It 
would cancel the MPPR cut to the professional component of radiology 
services through the end of 2012 and prevent it from taking effect in 
future years, pending more comprehensive study of the matter. 
Specifically, the Secretary of Health and Human Services would be 
prohibited from taking this action unless the reduction is based on the 
data, analysis, and conclusions of an independent expert panel convened 
by the Institute of Medicine.
  A similar bill, HR 3269, has been introduced in the House of 
Representatives and it enjoys the strong bipartisan support of more 
than 240 cosponsors. I urge my colleagues to support this bipartisan 
and budget-neutral approach to preserving patient access to community-
based diagnostic imaging services.

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