On March 17, the House Ways and Means Subcommittee on Health held a hearing on recommendations that Medicare develop quality standards for imaging services. In a press release announcing the hearing, Chair Nancy Johnson (R-CT) stated, “Given the significant growth in imaging services, we need to carefully examine the existing quality and safety of these services provided in physicians’ offices before requiring providers to meet new quality standards. Is there a problem, and if so, how widespread is it? What types of services are involved? I want to ensure that seniors have access to appropriate, safe, and high quality imaging services.”
Medicare Payment Advisory Commission (MedPAC) Executive Director Mark Miller explained that technological improvements to imaging services have made them more readily available to Medicare patients in physician offices and imaging centers, but quality and usage varies throughout the country. Summarizing MedPAC’s` recommendations, he urged Congress to direct the secretary of Health and Human Services “to set standards for providers who bill Medicare for performing and/or interpreting diagnostic imaging services,” adding, “No national Medicare standards for imaging apply to physician offices, and many imaging modalities, such as MRI, are not covered by an government standards…In addition, several Medicare carriers have minimum standards for the technical quality of some types of ultrasound studies performed in physician offices, but these standards have not been adopted nationally.” He highlighted the Mammography Quality Standards Act (MQSA), under which the Food and Drug Administration (FDA) “develops and enforces quality assurance standards for mammography equipment, technical staff, and the physicians who interpret mammograms. The GAO [Government Accountability Office] has credited the FDA standards with improving the quality of mammograms without decreasing access. Failure rates for image quality decreased from 11 percent before the act to 2 percent after.”
Testifying on behalf of the American College of Cardiology, Dr. Kim Allen said that advancements in imaging services “have changed the way cardiologists, oncologists, obstetricians and gynecologists, urologists, family practitioners, neurologists, orthopedic surgeons and other surgeons and many other physicians deliver patient care on a daily basis.” She also noted that technology improvements “have resulted in new imaging technologies that replace more invasive and generally more risky diagnostic procedures, and this trend of substitution isn’t just occurring in cardiology. For example, ultrasound guidance can allow needle biopsies to replace open biopsies of the breast, and it also can enable more accurate biopsies of prostate lesions with fewer tissue samples. In breast surgery, ultrasound-guided breast biopsies can reduce performance of potentially unnecessary and invasive procedures and surgeries. Ultrasound-guided breast biopsy allows for less-invasive evaluations of mammographic lesions, with more reliable tissue differentiation, more streamlined patient care and characterization, and improved staging of disease.”
Dr. James Borgstede, board of chancellors chair for the American College of Radiology (ACR), stated that the ACR “shares MedPAC’s concerns regarding the quality, safety and costs associated with the dramatic rise and variation in the volume of procedures utilizing high-cost diagnostic imaging modalities. In response to MedPAC’s and the private payer insurers’ desire to address this alarming imaging utilization trend, the College has worked closely with these groups to establish a Medicare physician payment policy focused on quality of care, patient safety and expertise of the physician interpreter to obtain needed cost savings and quality assurances in the area of diagnostic medical imaging services. More importantly, implementation of these recommendations will help assure that America’s over 65 population receives high quality, safe and effective medical imaging.” He also pointed to the MQSA standards, noting that “both MedPAC and the ACR have used MQSA’s accreditation and physician qualification to model their current policies,” adding, “ACR believes that if Congress thought it was important to ensure quality for the x-ray procedures involved in mammography, then it is logical that Congress would want to enact similar legislation for other imaging procedures that are more complex.”
