ACR comments on CHAMP passage

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The American College of Radiology (ACR) issued a statement reiterating its support for continuation of the State Children’s Health Insurance Program (SCHIP) but raising objections to the sustainable growth rate (SGR) provisions of the Children’s Health and Medicare Protection (CHAMP) Act of 2007 passed by the U.S. House of Representatives on Wednesday, Aug. 1, and by the Senate on Thursday, Aug. 2.

The Reston, Va.-based ACR said that the legislation calls for the SGR to be divided into six separate physician service categories: Primary Care and Preventative Services, Other E &M, Surgery, Anesthesia, Minor Procedures, and Imaging. Each service category will be allowed to grow at the same rate, with Primary Care allowed to grow more.

Variances in growth of the six categories will produce six separate conversion factors; slow growth categories will receive positive reimbursement updates, while fast growth categories will receive negative reimbursement updates, the ACR said.

The ACR stated that it is strongly opposed to the separate service category approach, given the fact that radiologists do not control the volume of growth of imaging and their reimbursements will be subject to the utilization patterns of ordering physicians. Reimbursements for referring physicians will no longer have any ties to the growth of imaging services.

CHAMP also contains additional cuts to the technical component (TC) for imaging services provided outside hospitals, according to the ACR. The cuts will be achieved by adjusting certain factors used to calculate practice expense. Currently, CMS assumes imaging equipment is being utilized 50 percent of the time that a facility is open. This provision directs CMS to assume a new utilization rate of 75 percent.

In addition, CMS assumes the interest rate for the purchase of imaging equipment to be 11 percent. This provision directs CMS to lower the assumption to the “fair market rate not to exceed 11 percent.” The final cut is achieved by raising the TC discount from 25 percent to 50 percent for certain same-day, contiguous body-part exams. The ACR said it is strongly opposed to these cuts and will advocate for their removal from the legislation.

The ACR stated that it supports a provision that would end the practice of global billing for imaging services and put in place a system where the TC and professional component (PC) must be billed separately.

Another provision would base Medicare payment for imaging services on certification of imaging equipment. The ACR said that it believes this language needs to be improved to more closely resemble accreditation requirements being implemented in the private sector. In addition to safe equipment, the ACR said that Congress must recognize the importance of qualified nonmedical personnel and standards for the rendering and interpreting physician, when it comes to complex modalities.

The ACR noted that the Bush administration issued a veto warning this week with an objection to the size and scope of the legislation. Should the President veto as expected, the ACR said that a likely scenario would be that the SCHIP and Medicare provisions would be split into two separate bills, with Congress addressing SCHIP in September and starting over with Medicare legislation later in the fall.