TAKE ACTION: Congressional Sign On Letter to CMS Addresses Proposed PET Cuts, Patient Impacts
Significant reimbursement cuts of up to 80 percent for myocardial PET (Positron Emission Tomography) scans in the physician office setting were included in the proposed 2020 Medicare Physician Fee Schedule.
The ACC, the American Society of Nuclear Cardiology (ASNC), American College of Nuclear Medicine (ACNM), the Cardiology Advocacy Alliance (CAA) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) are actively working together to address these cuts and the resulting ramifications to patient care if they are allowed to move forward without changes.
Most recently, the ACC, ASNC, CAA, SNMMI and ACNM have secured a Congressional sign-on letter to the Centers for Medicare and Medicaid Services (CMS) by Reps. Mike Kelly (R-PA), Ron Estes (R-KS), and Ron Kind (D-WI). This letter will be instrumental in amplifying the very real concerns of clinicians and patients about access to critical cardiovascular care.
ACC members are urged to email or call their respective members of Congress and ask them to sign the letter and voice concerns with CMS directly. Specifically, members of Congress should ask CMS to postpone implementation of proposed PET pricing and continue current levels while working with stakeholders to conduct a more complete analysis.
The cuts result from updates to the CPT codes used to report these services and review of the direct practice expense inputs that inform the calculation for the technical component payment. In particular, one driver of the cuts is a decision by CMS to assume a 90 percent utilization rate for PET cameras – an assumption that needs to be reconsidered. Additionally, pricing information for other equipment may also need further refinement.
In particular, focus has been placed on correcting the inputs and calculations for the payment formula through the public comment process and communication with policymakers. The societies have also been instrumental in educating CMS staff and more than 50 Congressional offices, including professional staff from relevant committees of jurisdiction, about the very real impacts on clinics and health centers across the U.S. that will have difficulty maintaining staff and operations at normal levels given the high purchase and operation costs associated with PET machines. Only the largest, and generally more urban, health centers would be able to afford equipment.
Keywords: ACC Advocacy, Current Procedural Terminology, Positron-Emission Tomography, Medicaid, Nuclear Medicine, Centers for Medicare and Medicaid Services, U.S., Urban Health, Medicare, Molecular Imaging, Fee Schedules, Patient Care
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