The Sustainable Growth Rate (SGR):
-For the 17th year in a row,
Congress had passed a patch to delay implementation of the SGR by almost
another year (10 months) earlier in 2014.
-There was hope that the
outlook for passing a permanent fix/repeal was good this year, and after
over a decade, the Senate finally voted in April 2015 to repeal the SGR!
Implementation of the
SGR was viewed as a doomsday scenario as it would mandate a steep
24% cut to Medicare which would cause a ripple effect throughout the
-One good thing about the
SGR Patch this year is that it supports the use of the ACRSelect, which
is the ACR’s Clinical Decision Support Tool, starting in 2017.
-The MPPR is the Multiple
Procedure Payment Reduction bill, which sought to cut Medicare payments
for the second contiguous body part read by the same radiologist the
same day by 50% because of perceived efficiencies of doing them both at
one time (for example, a CT Abdomen/Pelvis would get the payment for the
Pelvis portion cut).
-CMS stated that this was
based on research they conducted, yet they have never produced the data
to back up these “efficiencies,” which they are required to do by law.
-The latest iteration of the
MPPR is to cut the payment on the second procedure for any patient who
underwent even unrelated studies on the same day, even if they are read
by different radiologists.
Other Current Legislative
and Legal Issues:
Bill HR 4302:
-- Requires HHS secretary to
show data that supports the decision to implement the 25% reduction in
the professional component
-- Requires cuts greater
than 20% to be phased in over a 2 year period. We are advocating for a
permanent fix to the Sustainable Growth Rate formula.
CT Lung Cancer Screening:
The Affordable Care Act
requires insurers on exchanges to reimburse for preventative services
given a rating of B or higher by the USPSTF. Ironically, no similar law
requires Medicare to reimburse for an Annual Screening CT, despite the
There is a letter
circulating Congress which urges the Secretary of Health and Human
Services to add Annual Screening CT to the list of covered procedures
Dense Breast Legislation:
Requires imaging centers in
New Jersey to inform patients about the density of their breasts and the
resulting limits of mammography in detecting lesions in dense breasts.