Congresswoman Jackie Speier (D-San Francisco/San Mateo) today introduced the Integrity in Medicare Advanced Diagnostic Imaging Act of 2011, legislation that will cut wasteful Medicare spending and protect patients from dangerous and unnecessary exposure to radiation.
Current law bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but the in-office ancillary services exception allows physicians to be reimbursed for CT, MRI and PET scans that they perform within their own offices. This exception was designed so patients could get tests done on the same day as their appointment, but evidence shows this happens less than ten percent of the time. The intent was patient health and convenience, but the result has been physician abuse. Today, physicians purchase these machines because with a fee for service payment system, they know that they are big profit drivers. As a result, imaging has ballooned into a $100 billion industry—$14 billion of which is absorbed by Medicare.
According to the Medicare Payment Advisory Commission, an independent agency that advises Congress on issues affecting Medicare, between 1980 and 2006, per-capita radiation dosage for clinical imaging exams increased almost 600% in the United States.Not only do these scans do nothing to make Americans healthier, they deliver almost half of the estimated collective dose of radiation exposure in our country and are relatively unregulated.
“The financial interest of physicians should not be a determining factor in prescribing care for patients,” Speier said. “It is terrible to think that this loophole is being abused to enrich doctors while their patients are being unnecessarily exposed to radiation. This bill puts patients first and potentially saves the government billions of dollars in wasteful expenditures.”
The Integrity in Medicare Advanced Diagnostic Imaging Act will eliminate certain advanced diagnostic imaging services, including MRI, CT, and PET scans from the in-office exception. The bill does not include imaging services performed for the purposes of radiation therapy treatment planning or in conjunction with interventional radiological procedures.