By Matthew Perrone
Arizona Daily Star
June 26, 2007
Medical imaging equipment makers are lobbying to overturn Medicare cutbacks after weathering some of the worst sales numbers in recent memory.
The cuts took effect in January and reduce how much doctors are paid for running X-rays, medical resonance imaging and other tests on patients enrolled in the government-run health program for seniors. For example, nationwide reimbursements for MRI scans, one of the most commonly performed procedures, dropped 38 percent on average, with payments varying by county.
The Medicare payment changes, which are expected to save $2.8 billion over five years, sent sales of scanners made by GE, Siemens AG, Toshiba Corp. and others tumbling more than 20 percent last quarter, according to data provided by an industry group.
Medicare officials say they are monitoring whether patients are having trouble getting access to imaging. And they point out that payment reductions don’t affect hospitals, where the majority of imaging services are performed.
Washington’s unresponsiveness may reflect a more troubling trend for these and other medical technology companies: Health-care experts that advise lawmakers are not convinced that more medical technology translates into better health care.
“We have communities with half as many scanners as those in other parts of the country, and their outcomes are just as good, and in some cases better, than communities spending twice as much on imaging,” said Elliot Fisher, a professor at Dartmouth Medical School who consulted for government advisers on the imaging issue.
Research by Fisher and his colleagues found that patients live about the same length of time regardless of their access to imaging.
Imaging industry representatives counter that basing the technology’s value on whether the patient lives or dies isn’t valid.
http://www.azstarnet.com/allheadlines/189110
Comment:
By Don McCanne, MD
Currently the greatest increase in Medicare spending has been due to the increased use of medical imaging. Some of it is appropriate, and some of it is not. As stewards of our public funds, Medicare officials have an obligation to see that we are receiving appropriate value for our health care spending.
There have been some disturbing developments in medical imaging in recent years. There has been an increase in independent, entrepreneurial imaging centers which are not linked to hospitals. Specialty groups that order many scans frequently purchase their own units, providing physicians with even more incentives to order scans. This increased capacity has been demonstrated to increase the number of imaging procedures performed. Elliot Fisher and his Dartmouth colleagues have demonstrated that this increase in volume has not improved outcomes, yet it has decreased value of our Medicare purchasing. It is this over-utilization that is targeted by the reductions in Medicare rates for imaging services.
The opponents of government insurance programs will likely claim that Medicare’s reduction in payments for imaging services will reduce incentives to develop new innovative technology. No. Medicare continues to adequately fund appropriate imaging services.
The message is that Medicare will pay for beneficial technology, but it will not waste taxpayer funds on expensive technology that fails to provide health care value. It is a message to the technology industry that they should continue to provide us with new technology that provides health care value, but don’t sell us excesses that we don’t need and really can no longer afford. The tech industry will not go away. They will still want their portion of the $2.2 trillion that we are already spending on health care.
This important oversight function is an advantage of having a single government program that can identify deficiencies in our financing of health care, and then put in place policies that correct them. The thousands of private plans with their fragmented proprietary information have very little capability of identifying these problems, much less having a credible basis for putting in place global policies that would increase health care value.
Just think of how much more effective we could be in value purchasing of health care if all of us were covered by our own single payer program of national health insurance. That would be so much better than being controlled by an industry that declares “whether the patient lives or dies isn’t valid.”