Policymakers urged to preserve access to advanced imaging in final health care reform legislation

Excise tax threatens continued access to high quality health care

Survivors and patients with cancers and heart disease, along with patient advocate organizations and physicians, today urged policymakers to enhance early diagnosis of deadly diseases by preserving access to advanced imaging, such as MRI and CT scans, in final health care reform legislation.

Specifically, hundreds of rally participants expressed grave concern about the "triple threat" facing life-saving medical imaging services -- drastic Medicare reimbursement cuts included in health care reform legislation, arbitrary changes to the 2010 Physician Fee Schedule and billions of dollars in excise taxes on imaging equipment -- all of which would turn back the clock on the war against cancer and other serious diseases by inhibiting patients' access to the early disease detection that diagnostic imaging delivers.

The most recent of these threats, a $40 billion excise tax on medical devices has the potential to have serious, systemic and long-term repercussions for the quality of American health care, as it will stifle the innovation of new imaging and cutting edge cancer-therapy technologies that can detect disease earlier, personalize disease treatment while preserving quality of life and deliver better outcomes with less radiation.

In a letter to President Obama and Secretary Sebelius, 20 patient advocacy organizations wrote that they were gratified to hear President Obama point out in his recent address on health care that early disease detection makes sense because "it saves money, and it saves lives." With that in mind, the groups wrote that "further deep reductions in Medicare reimbursements for diagnostic imaging would jeopardize the health of America's seniors by delaying or precluding their access to the front-line tools that turn early detection into effective treatment and patients into survivors."

Knowing that new cancer cases in the U.S. are projected to rise by 45 percent over the next 20 years, with a "dramatic spike" predicted among elderly and minority populations (according to the Journal of Clinical Oncology), the groups also expressed concern in their letter that "limiting access to vital advanced imaging services will counteract efforts to identify and treat disease early, with the net result of increasing --- rather than decreasing --- overall healthcare costs."

"Twenty-eight organizations advocating on behalf of patients and seniors have now expressed support for access to diagnostic imaging by urging Congress and the Administration to forgo another round of deep cuts to reimbursements," said Andrew Spiegel, CEO of the Colon Cancer Alliance.

In addition to today's letter release, 15 patient advocate organizations wrote to Congressional leaders in July, saying: "We are deeply concerned that additional unwarranted cuts to medical imaging will hamper our fight against these deadly diseases." Seven organizations signed both letters.

"We know that early disease detection dramatically improves the chances of survival," said Sheila Ross, special counsel, Lung Cancer Alliance and two-time lung cancer survivor. "If imaging reimbursements are further reduced and increased taxes are imposed on such technologies, in the end it will be the patients who will suffer the most."

The organizations that signed today's letter are: American Federation for Aging Research, American Pain Foundation, Black Women's Health Imperative, Brain Injury Association of America, California Consumers United, Coalition for Pulmonary Fibrosis, Colon Cancer Alliance, Connecticut Breast Health Initiative, David's Fight, Emergency Coalition to Save Cancer Imaging, Gilda's Club Quad Cities, Gregory M. Hirsch Memorial Foundation, Hypertrophic Cardiomyopathy Association, Kidney Cancer Association, Lung Cancer Alliance, Patient Advocates for Advanced Cancer Treatment, SemiColon, Sudden Cardiac Arrest Association, Washington State Prostate Cancer Coalition, and YES! Beat Liver Tumors.

As the patient advocate organizations unveiled their letter, the Access to Medical Imaging Coalition (AMIC) also released a Moran Company analysis of 2008 Medicare claims data showing that the volume of advanced imaging is growing more slowly since the implementation of the Deficit Reduction Act of 2005 (DRA). A previous Moran and Company analysis showed that Medicare spending on advanced imaging was reduced by 19.2 percent from 2006 to 2007 and volume of service grew by only 1.9 percent. Of particular note, the new analysis showed that from 2007-2008:

• Use of CT, MR, PET and nuclear services grew by only 1.1 percent - even slower growth than the modest 1.9 percent growth from 2006 to 2007.
• Use of mammography and DEXA (bone density screening to detect osteoporosis) both continue to decline in volume. Screening mammography volume fell nearly 30 percent (from 0.15% growth in 2006 to 2007 to -.20%), while DEXA volume in 2008 dropped 0.4 percent relative to 2007 (double the decline from 2006 to 2007).
• Use of MRI decreased by -0.3 percent between 2007 and 2008 and the growth rate for CT volume was cut almost in half (4.2 % compared to 2.6%).

"Utilization of advanced imaging services continues to be slower in the post-DRA environment than in the prior period," said Don Moran, president of the Moran Company. "Contrary to the assumption that advanced imaging spending is rapidly increasing, the 2008 data appear to confirm the deceleration of imaging cost growth first observed in the 2007 data. Policymakers may wish to consider this trend when considering changes to imaging coverage and reimbursement."

Tim Trysla, executive director of the Access to Medical Imaging Coalition said: "MedPAC is ignoring imaging spending and use trends from 2006 to 2008 after the DRA went into effect. It's misleading and lacking in credibility for MedPAC to make policy recommendations while examining an environment that no longer exists. Policymakers must take into account the impact of the DRA and make public policy decisions based on up-to-date spending and use data."