A Wave Of Payment Policies Is
Sweeping The Nation [continued]

what will the future hold? Perhaps one of the most important developments related to the issue of reimbursement is the recent activity in Washington, DC that will have ramifications for Medicare payment policy on the national level. The Medicare Payment Advisory Commission (MedPAC), an independent federal body established by the Balanced Budget Act of 1997 (P.L. 105-33), serves to advise Congress on issues affecting the Medicare program. MedPAC not only advises Congress on payments to private health plans participating in Medicare, but also analyzes access to care, quality of care, and other issues affecting the overall program as well as the nation's healthcare system in general. MedPAC recommends changes to payment and other policies that are designed to make payments more accurate and improve the value of care. MedPAC's goal is "for Medicare payments to cover the costs efficient providers incur in furnishing care to beneficiaries."

Within the March 2005 MedPAC report, the topic of the rapid growth related to Medicare spending for imaging services was addressed within Chapter 3, entitled, "Issues In Physician Payment Policy."

The MedPAC report outlined several factors as justification for the Centers for Medicare and Medicaid Services (CMS)' future setting of standards for physicians who bill Medicare for the professional component of imaging studies:

• advances in imaging technology that have made it possible to provide services in non-hospital settings;
• the migration of imaging from hospitals, which establish criteria for who may interpret studies, to non-facility settings, where there are often no such rules;
• rapid growth in physician fee schedule spending for imaging services; and
• variations in the quality of physician interpretations and reports, which can affect treatment decisions.

Within the chapter entitled "Issues In Physician Payment Policy," MedPAC provides Congress with potential solutions toward enhancing the quality of care as well as controlling spending. Here, MedPAC announces specific recommendations related to diagnostic imaging studies and this particular aspect of healthcare delivery:

The full version of the March 2005 MedPAC report to Congress can be accessed at: http://medpac.gov/publications/congressional_reports/Mar05_Ch03.pdf.

Related to the recommendation suggesting the development of standards for physicians who interpret imaging studies (3C), MedPAC directs that CMS should develop standards for physicians who bill for interpreting imaging studies (the professional component) to ensure that they are qualified to do so. While acknowledging the fact that the implementation of these recommendations would represent a new direction for Medicare, the MedPAC report comments, "this policy should improve diagnostic accuracy and treatment. It should also help control the growth of imaging spending by restricting payment for interpretation to only qualified physicians."

As part of recommendations 3C and 3D, a statement synonymous with facility accreditation was made: "The Secretary [of Health and Human Services] should select private organizations to administer the standards." The report discussed the differences amongst the many medical specialties utilizing specific imaging modalities, stating, "Because physician specialty organizations often have different criteria for determining when a physician is qualified to provide a service, CME should consult with physician specialty groups and private accreditation organizations when developing standards for Medicare payment. The Intersocietal Accreditation Commission (IAC) has demonstrated that it is possible for different specialties to agree on common standards. The IAC uses a process in which representatives of several specialty groups jointly develop facility and physician standards for three types of imaging services: echocardiography, nuclear medicine, and vascular ultrasound."

The report makes specific reference to the ICAEL accreditation program and uses the ICAEL Standards as an example, stating, "Physicians who interpret echocardiography studies at providers accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories must complete a six-month training program or have three years of interpretation experience. Some accreditation programs also review a sample of reports produced by interpreting physicians for completeness and accuracy."

Accreditation allows facilities to demonstrate quality to insurance carriers, including efficiency of operations by following established policies and procedures; demonstration of a commitment to quality and continued education; and adherence to nationally standardized protocols and metrics for quality assurance.