Philadelphia Society of Radiologic Technologists
An Affiliate of the American Society of Radiologic Technologists
Message from President and Board Chair
Debbra Soffer & Bernadette Garofola
CARE Bill Updates-April 27, 2009
Consistency Accuracy Responsibility and
Excellence in Diagnostic Imaging and Radiation Therapy
Issues ASRT are focusing on in 2009
·* Enactment of the CARE Bill
·* Scope of Practices
·* Facility Accreditation standards
·* Reimbursement for Radiology Assistants
·* Maintaining reimbursement levels for technical component of imaging services
·+ Creating equilibrium between employer needs and workforce development
We are currently in the 111th Congress—
The ASRT and multiple other imaging organizations have joined in the fight for the CARE Bill that has been going on for the past 11 years. With each new Congress we need to obtain 2 sponsors and 2 co-sponsors. These 4 representatives would champion the cause and try their best to gain supporters in the Senate and the House. Currently Senator Enzi from WY has agreed to be a sponsor for the Senate; one down 3 to go. Once the sponsors/cosponsors are obtained the Bill can be re introduced to Congress and assigned a number.
Democrats are the majority in this administration and may speed the legislature. The House currently has 254 Dem, 178 Rep and 3 vacancies; the Senate 57 Dem, 41 Rep and 2 Independents. Then we basically need 60 votes in the Senate to have the bill pass in the Senate. This takes much work from people like you and me to write your representatives in the House and Senate to support the CARE Bill.
CARE Bill in the 110th Congress—
·* House (HR 583) died without committee action with 150 Bipartisan cosponsors.
·* Senate (S1042) passed the Senate HELP Committee with amendments and 27
cosponsors. The Bill died before moving to Senate.
·* Medicare Program had jurisdictional issues between the HELP & Finance Committees
Interference from imaging provisions in SCHIP & MIPPA
Current Challenges to the CARE Bill in 2009—the bigger and smaller picture.
What is happening around us in the “ bigger picture” is affecting the normal steps and tedious tasks that need to be taken, these issues are; the overall economy, education reform, Health Care (Medicare Reform, Universal Health Coverage, Electronic Health Records), overseas troop reduction and the environment.
Your representatives are torn between their old issues they were fighting for and current ones they are expected to fight for due to what President Obama and his current administration is trying to change. That is the bigger picture the “smaller picture” is:
Concerns:
·* Medical Imaging equipment manufacturers mostly ultrasound manufacturers- ultrasound
equipment has been sold to all types of offices; general physicians, cardiologists, OB-
Gyn, vascular surgeons. They either scan patients themselves or sometimes hire
unqualified personnel to perform the exams and they bill directly for the studies.
Accreditation organizations are uniting with Medicare and United Health Care to stop
wrongful use of ultrasound; by not reimbursing for exams that have not been performed
by qualified individuals.
·
* OB-GYN and ophthalmology organizations
·* Crisis Pregnancy centers—nurses want to be able to do ultrasounds at these facilities
·* Infusion nurses for PICC guidelines-nurses/physicians want to be able utilize ultrasound
equipment to localize the proper vessel to insert picc lines.
Sonography concerns coupled with election year politics brought the CARE Bill’s progress to a stand still the end of 2008 to present. The CARE Bill applies to Medicare at this point.
Pennsylvania and New Jersey Contingent’
From left to right: Debbra Soffer, PhilaSRT President, Sharon Miller, Penna. SRT Chair, Bernadette Garofola, PhilaSRT Board Chair and NJ Society Member; Barbara Cooper, CNMT, Doug Borsich, CNMT both Society of Nuclear Medicine Representatives and Joyce Harrell, Mammographer, Pa.
Medicare Improvement for Patients and Provisions Act, (MIPPA) was formed in July of 2008.
Disabled patients < 60 yrs old can apply for Medicare. MIPPA contains provisions for facility accreditation standards for “advanced Diagnostic Imaging” i.e. CT, MR, NM & PET (30% of the imaging done). MIPPA specifically EXEMPTS General X-ray, fluoroscopy, all Ultrasound (general, cardiac, vascular, ob-gyn) and Radiation Therapy which is the other 70%. Why were they excluded? MIPPA’s focus was on high cost imaging procedures. X-ray and ultrasound are less expensive and they are most frequently performed and often used to determine if the more expensive CT or MR is needed.
CHAMP & SCHIP morphed into MIPPA. The CARE Bill introduced in 2008 included provisions for the Accreditation of all diagnostic medical imaging (SCHIP).
Advanced Diagnostic Imaging Accreditation was supported by the ACR and Physician Organization for facilities vs. office based imaging. Concerns were raised.
MIPPA --by Jan 2010 CMS must deem accreditation necessary prior to payment (ACR & Intersocietal Organizations including Cardiology). By Jan 2011 ALL advanced diagnostic imaging procedures will only be paid for by Medicare if the facility is accredited. Hospitals are exempt because imaging standards are provided in JACHO.
ACR Accreditation standards; ACR offers accreditation for facilities providing CT, MR, NM & PET. The standards do not require post primary specific certification. Technical standards are; registration by ARRT (any modality) &/or unrestricted state license.
Intersociety Accreditation standards
The Accreditation Commissions have programs for CT (ICACTL), MR (ICAMRI) and NM (ICANL). The standards have a variety of pathways.
ASRT Position
MIPPA’s standards were/are a result of the CARE Bill. The ACR and IAC currently do not accredit x-ray or ultrasound facilities (echocardiography is accredited b y ICAEL and vascular US is accredited by the ICAVL. Only 50 % technologists performing CT are certified in CT, they should possess prost primary certification in those disciplines and are getting around it by having Quality Medical Physicists at each facility.
Cost Savings: MIPPA’s facility accreditation standards are not expected to provide any immediate direct cost saving to Medicare but may slow down spending in Advanced Diagnostic Imaging exams. So the key is to balance access to patients and quality.
Key Debate is expansion of the New Government Program and the country is not ready for a single Payor Health Care. The CARE Bill will decrease repeat exams by 1% which equates to approximately $100 million in savings in one year by having the properly educated and credentialed individuals performing diagnostic imaging. This will facilitate faster diagnosis and treatment and a better outcome overall.
This amount was figured on radiology procedures alone.
If you are interested in supporting the fight for quality diagnostic imaging, PLEASE support the CARE Bill, Bernie and I will be more than happy to guide you on how to write your representatives. Please email dhsoffer@verizon.net or berniegarofola@hotmail.com. Or visit www.ASRT.org
Regards,
Deb Soffer, PhilaSRT Legislative Committee Co-Chairperson 2008-2009
Bernie Garofola, PhilaSRT Legislative Committee Co-Chairperson 2008-2009
ASRT Grass-Roots Committee Member 2003-present
Ms Monica Volante, Legislative
Director for Congressman Joseph Pitts, with the group.
Joyce Harrell, Debbra Soffer,
Senator Lautenberg and Bernadette Garofol
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