Diagnostics & Imaging Week

The new White House budget (Diagnostics & Imaging Week, Feb. 9, 2006) has produced a variety of reactions, primarily, of course, from those who will feel the pinch of reductions – those reductions a product of current budget tightening in domestic spending.

Among those expressing particular alarm are providers of imaging services in physicians offices and by freestanding centers. The cuts involve what is called the "technical component" payment, what is paid for all services pertaining to performing the imaging procedure, including technician and equipment costs. It will impact various advanced modalities, from MRI to positron emission tomography, in non-hospital settings, and these providers say the reductions will cause them significant difficulty.

Among these, Radiologix (Dallas) – which reports that it derives about 25% of its imaging center income from Medicare – says that if the cuts had been in place during calendar year 2005, they would have reduced the company's revenue by about $13.3 million.

Randy Fuller, hospital segment manager for GE Healthcare Financial Services, told Diagnostics & Imaging Week that the reductions, "from our standpoint, are not totally unexpected."

He described the cuts as an attempt to "level" the playing field between hospital and non-hospital centers, but will mean "from 3% to 4% to 5% off the bottom line" for the non-hospital providers. "It's a fairly significant impact on most of those providers," he judged, adding that they will need to find creative ways to deal with it.

Fuller noted the large benefit of diagnostic systems such as MRI and computed tomography to better assess medical problems and avoid unnecessary biopsy procedures, but also that the relative larger costs of these modalities have drawn the attention of the Centers for Medi-care & Medicaid Services (CMS; Baltimore) and other reimbursement systems.

The large providers will be best able "to manage their way out of this," he said, by broadening their offerings, but he added that "the lower end of the market is going to be pretty challenged." These include "providers not doing very well to begin with and those that don't have a lot of market presence to leverage to increase their position."

GE Financial, he noted, keeps assessing these conditions as "an area we'd love to help them with. We can look at how we could support them and their needs."

Some specifics of the cuts:

The Deficit Reduction Act, signed by President George Bush on Feb. 8, provided for the technical component to be capped at the lesser of reimbursement under the Medicare Part B physician fee schedule or the Hospital Outpatient Prospective Payment System (HOPPS) schedule.

Currently, the technical component of these non-hospital imaging services is reimbursed under the Part B physician fee schedule, generally allowing for higher reimbursement than under the HOPPS. Under the DRA, these facilities will be reimbursed at the lower of the two schedules as of Jan. 1, 2007.

The DRA also codifies the reduction in reimbursement for multiple images on contiguous body parts previously announced by CMS.

Last November, CMS said that it would pay 100% of the technical component of the higher priced imaging procedure and 50% for the technical component of each additional imaging procedure for imaging procedures involving contiguous body parts within a family of codes when performed in the same session. Under current methodology, Medicare pays 100% of the technical component of each procedure.

CMS will phase in this rate reduction over two years, so that the reduction will be 25% for each additional imaging procedure in 2006 and another 25% in 2007.

Study to look at genetic source of diseases

The National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH; Bethesda, Mary-land), in collaboration with the Boston University School of Medicine, has reported the launch of a comprehensive genetic research study to identify genes underlying cardiovascular and other chronic diseases.

The new research effort, the Framingham Genetic Research Study, will be part of the NHLBI's long-running Framingham Heart Study (FHS). It will involve up to 500,000 genetic analyses of the DNA of 9,000 study participants across three generations.

The NIH's National Center for Biotechnology Information, part of the National Library of Medicine, will help develop a study database that will be made available at no cost to investigators, enabling them to search for associations between genes and diseases.

"This important study will take genetic research in the Framingham study to the next level – accelerating discoveries on the causes, prevention, and treatment of major chronic diseases," said NHLBI Director Elizabeth Nabel, MD. "Using the latest technology, researchers will be able to obtain more information about the connection between unique genetic variations in DNA and cardiovascular disease risk factors as well as the genetic basis for heart attack, stroke, and other chronic diseases."

Since 1948, the Framingham Heart Study has studied the health of many of the Massachusetts town's residents. The study has been the source of key research findings regarding the contributions of hypertension, high cholesterol, cigarette smoking and other risk factors to the development of cardiovascular disease.

"This unique opportunity to increase our knowledge about health and disease is made possible by three generations of Framingham study participants who have donated their time to advance medical research," said Karen Antman, MD, dean of Boston University School of Medicine and provost of Boston University Medical Campus.

The study will take advantage of knowledge gained from the Human Genome Project's sequencing and mapping of all human genes and from the recently completed HapMap Project, which charted the pattern of genetic variation in the human genome.

The Framingham Genetic Research Study will use recently developed technology that now allows rapid genotyping of about 500,000 SNPS in each individual. Computer programs will then help scientists relate these alterations to many of the clinical and laboratory measurements made of study participants during their examinations.

Christopher O'Donnell, MD, associate director of the FHS and scientific director of the new project, said, "Then we hope to identify the genetic variations that are most strongly related to participant characteristics such as levels of cholesterol and systolic blood pressure."

AAA screening wins some coverage

Congress has passed legislation that includes Medicare patient coverage of a one-time ultrasound screening for abdominal aortic aneurysms (AAAs); frequently called "the silent killer," burst aneurysms take about 15,000 lives annually in America without any symptoms. Key provisions of the Screening Abdominal Aortic Aneurysms Very Efficiently Act (SAAAVE) were part of the final budget reconciliation package signed by the president.

The legislation was first introduced in 2004. Patients at risk for AAA will receive the benefit as part of their "Welcome to Medicare" physical. The covered patient population includes men age 65 and over who have smoked more than 100 cigarettes in their lives, plus women with a family history of AAAs. Coverage will begin in early 2007.

The SAAAVE Act was sponsored by Christopher Dodd, (D-Connecticut) and Jim Bunning (R-Kentucky) in the Senate, and John Shimkus (R-Illinois), Ron Lewis (R-Kentucky) and Gene Green (D-Texas) in the House.

"This is a tremendous step forward and a great victory for patients at risk for life-threatening abdominal aortic aneurysms," said Robert Zwolak, PhD, professor of surgery at Dartmouth Medical School (Hanover, New Hampshire) and chairman of the National Aneurysm Alliance (Washington) and instrumental in pushing for the legislation.

Medtronic (Minneapolis) – which through its charter affiliation with the National Aneurysm Alliance has been providing free screenings for AAAs since 2004 – also lauded the bill. The company said that over the past two years, more than 18,000 people have been screened at 135 locations around the country, and more than 400 potentially life-threatening AAA conditions have been detected.

"We need to remain vigilant in addressing this problem because so many lives are at stake," said Scott Ward, president of Medtronic Vascular (Santa Rosa, California).