Senate roundtable discusses reducing imaging reimbursement

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In the first of three roundtables on healthcare delivery system reform held by the Senate Finance Committee, participants this week discussed increasing primary care physician payments by reducing payments to imaging services providers.

Senate Finance Committee Chairman Max Baucus, D-Mont., said the committee will hold a closed door walk-through on April 29 to review tentative legislation aimed at delivery reform, according to the American College of Radiology (ACR). A later markup to deal with comprehensive health legislation is scheduled for June. The roundtable discussion focused on reform of the payment system, the current shortage of primary care physicians and means for incentivizing doctors to join this field, bundling and the treatment of chronic conditions.

The ACR reported that "an underlying theme was the need to promote and reward primary and preventative care and increase care coordination via bundling and other innovative payment and delivery approaches."

The attendees agreed that changes in Medicare can encourage healthcare delivery system reform but only if the program has more latitude and resources, the college said.

Allan M. Korn, MD, senior VP and chief medical officer of Blue Cross Blue Shield Association, said that "increasing payments to primary care physicians, while at the same time strengthening the foundation of the overall primary care work force, are critical delivery system reforms to ensure a high performing healthcare system."

To increase payments, Korn recommend adjusting payments through the Resource Based Relative Value Scale (RVS) to give primary care providers a 5 percent relative increase in 2010; 10 percent in 2011; and 15 percent thereafter. He stated that paying for this could be done primarily by reducing payments for imaging services to providers who rely heavily on "costly imaging machines."

He also recommended a change to the membership of the RVS update committee and an increase in the proportion of primary care physicians to at least 35 percent of the medical professionals on the committee, and an addition of private payers as non-voting members.

Glenn Steele, president of Geisinger Health System, said that one step toward reforming Medicare is to redesign the Centers for Medicare & Medicaid Services (CMS) around patient-centered care. He said CMS should be redesigned as an "engine of innovation," beginning with a patient-focus on those groups that are the most expensive. Steele also urged that CMS be given more latitude to institute procedures that allow the agency to process which reforms are working more quickly, rather than wait for demonstration projects that can take years.

Former CMS Administrator Mark B. McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said reform may require some upfront spending but ultimately should have to demonstrate quality improvements and cost containment. He mentioned that CMS will need more money for incentivizing primary care physicians and the medical home model. 

Other witnesses agreed but also said efforts must be made to address work force shortages in primary care through loan forgiveness programs, the use of primary care providers other than doctors and other measures. 

On health IT, Ronald Williams, CEO of Aetna, said potential changes for CMS could be a public and private partnership that enriches the claims database and increased flexibility that will allow for measures, such as alerts during health screenings.

Two additional roundtables will be held on May 5 and May 14, when the committee will discuss the expansion of healthcare coverage and the financing of health reform, respectively.