Home » SCMR working groups » WG - USA

WG - USA

The chair of this WG is Scott Flamm

Welcome to the United States working group:
This is the chief advocacy group for CMR users in the United States.  The WG has a primary aim of understanding the political and economic factors impacting the practice and continued development of CMR in the United States, relating that information to the US membership, and, as appropriate, facilitate and engage in CMR advocacy.

News: Working group members recently have participated in coordinated efforts to increase the RVUs associated with CMR add-on flow codes.  See below for news.

Meetings: We hold regular meetings at the SCMR scientific meetings. Our next meeting will be at the 13th Annual Scientific Meeting to be held at the Sheraton Downtown Phoenix, 21-24 January, 2010.

Contact us
Scott Flamm, M.D. at Cleveland Clinic: flamms@ccf.org or 216-444-2740

Last updated
13 November, 2009

U.S. Chapter Working Group NEWS

Medicare reimbursement update -- Congress fails to act to prevent 21.2 percent cut

SCMR PECOS Update

November 2009

Regulatory Issues Impacting Technical Component Reimbursement
SCMR is deeply concerned regarding the 2010 Final Medicare Physician Fee Schedule and the detrimental impact it will have on the ability of patients to access much needed imaging services. The conversion factor and practice expense cuts to the technical component of the Medicare Fees listed below are additive and SCMR wants members to understand the significant reimbursement challenges we collectively face.  We have developed this document to attempt to describe each of the components and the impact on fees.
SCMR DRA (Deficit Reduction Act of 2005) info sheet
CMS Final 2010 Physician Payment Rule

**Important Upcoming Changes in Medicare Coverage and Coding for Cardiac Magnetic Resonance Imaging
Washington Report (June 2009)

Over the last several months, President Obama, Congress, and other policymakers have engaged in a flurry of activity that will directly affect the delivery of health care services in the United States.

Below is a summary of key events that have occurred to date.  If you have questions or would like more detailed information, please contact SCMR's advocacy consultants - -Carrie Kovar (carrie@korrisgroup.com) or Denise Garris (denise@korrisgroup.com).

Economic Stimulus

The American Recovery and Reinvestment Act, aka "the Economic Stimulus bill" was enacted into law in February 2009.  Healthcare figured prominently in this law aimed at jump-starting the economy and improving the nation's infrastructure.  Highlights of the health care provisions are noted below.

Funding for Health Information Technology (HIT)

- Provides $19 billion in HIT infrastructure and Medicare and Medicaid incentive payments to encourage doctors, hospitals, and other providers to use HIT to electronically exchange patients' health information.

Preventative Care, Evaluation of Health Care Treatments

- Earmarks nearly $1 billion to fight preventable chronic diseases and infectious diseases. This includes hospital infection prevention, immunization programs, and evidence-based disease prevention.

Comparative Effectiveness Research (CER)

- Provides $1.1 billion to compare the effectiveness of medical treatments.   The law stipulates that funding may not be used to mandate coverage or reimbursement policies. 

Funds are to be used to:

1) Conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions;

And

2) Encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.

It is unknown at this time exactly what role cost effectiveness will have in CER.  The Institute of Medicine, Agency for Healthcare Research and Quality, and the Federal Coordinating Council for Comparative Effectiveness Research have each begun to solicit public comments on research priorities.  Research funding must be obligated by September 30, 2009

President Obama Sends Budget Proposal to Congress

Below is a brief overview of the health reform and Medicare/Medicaid provisions contained in the President's FY 2010 budget proposal.

Health Care Reform Fund

- Proposes $630 billion over ten years for an initial reserve fund to be used to finance health care reform.  The fund would consist of half new money and half from savings achieved through reductions in other areas of health spending.

Medicare and Medicaid Provisions

- Expresses commitment to reform the current sustainable growth rate (SGR) payment formula for physician services.

- Proposes to require prior authorization of imaging services provided under the Medicare program.

- Advocates continued payment bundling for services commonly performed together, thereby leading to payment reductions for providers.

- Proposes to address financial conflicts of interest in physician ownership of specialty hospitals.

- Provides increased funding for Medicare and Medicaid demonstration and pilot projects to evaluate payment reforms, quality of care initiatives, increase beneficiary outreach and education on program benefits.

Health Care Reform Tied to Fiscal Year 2010 Budget Resolution Approved by Congress

A $3.5 trillion budget resolution for fiscal year 2010 was recently approved by Congress, providing the structure for debate on appropriations for all government programs later this year.  Under the budget resolution, if health care reform legislation is not approved through regular procedures in the next several months, all committees with jurisdiction over healthcare reform will be required to report out legislation by October 15, 2009.

Medicare Payment Advisory Commission (MedPAC) Issues Report to Congress

In a March 2009 report to Congress, MedPAC, an advisory body established by Congress to act make recommendations on Medicare programs and procedures, suggests a significant reform in payment for advanced diagnostic imaging services. Specifically, MedPAC recommended that Congress consider hiking the equipment utilization rate percentage assumption from 50 percent to 90 percent, thereby assuming advanced imaging equipment is in use 45 hours per week, not 25 hours per week as in current estimates.  The effect of this change would be to drive down practice expense values and therefore reduce reimbursement for imaging services.

Senate May Act Soon on Health Care Reform

The Senate Finance Committee may be ready to debate a health care reform proposal as early as June 2009.  The Committee has issued a series of policy options documents for public comment, on issues ranging from physician and hospital payment reforms, to imaging policy, and proposals for long term investments in health care research and quality measurement.
Of note, one proposal would require the Secretary of Health and Human Services to work with medical specialty societies and national standards organizations to designate appropriateness criteria and related measures for physicians to utilize in reporting on the provision of imaging services to specific patients.  The proposal also calls for implementation of a confidential feedback program to track and report on physician adherence to appropriateness criteria.  Effective 2013, providers would face a payment reduction of five (5) percent of their total Medicare allowable charges if feedback reports indicate that they are outliers for appropriate ordering of imaging tests.
In addition, the Senate Finance Committee set forth a proposal to require physicians to disclose to patients any ownership interest in equipment or a facility where a patient may be referred for diagnostic imaging services.  Tied to this proposed disclosure requirement is a troubling provision that would require physicians to give patients a list of alternative imaging service providers in their area.