Cherrill Farnsworth

As year-end quickly approaches and our 2003 budgets are before us, it is an appropriate time to pause and assess the state of public policy and its impact on the radiology industry. Not long ago, all of us were focused on the Bush health care agenda and where that would take us. The radiology community had met with Tom Scully, administrator of the Centers for Medicare & Medicaid Services (CMS), regarding the 2002 cuts to the conversion factor and the cut to the technical component in radiology. We were all focused on the Health Insurance Portability and Accountability Act (HIPAA) and its impact on our operations and near-term financial health. We also had all heard about or read the Institute of Medicine's Report on health care quality, Crossing the Quality Chasm: A New Health Care Delivery System for the 21st Century. A prescription drug benefit for seniors was being heavily discussed and debated. The Patient Bill of Rights was on the horizon with the ability for enrollees to sue their health insurer.

Then the war on terrorism escalated, the economy took a protracted downturn, elections that could throw the Senate margin to either party approached, and the administration introduced the possibility of war with Iraq. With all of this on the minds of our national leaders and our fellow citizens, work on the health care agenda has dropped on the priority list, but still moves forward. The biggest initiative that we know will occur is HIPAA. The August release on this subject in the Federal Register reaffirmed the April 14, 2003, deadline for HIPAA enforcement of the privacy regulations for most covered entities. The exceptions are health plans with less than $5 million in revenue and practices with 10 or less full-time employees who do not submit claims electronically. Tommy G. Thompson, Secretary of Health and Human Services, has named the Office of Civil Rights as the enforcement arm for HIPAA and the initial hiring of officers has been accomplished. President Clinton signed the HIPAA bill, but the successful operationalizing of the bill looms large in the Bush agenda for 2003.

The Patient Bill of Rights has fallen prey to endless emotional debates and negotiations about caps on liability and tort reform. It is unlikely to become law in 2003, if ever, with new priorities, the war, and the economy, before Congress. The much-anticipated Medicare drug benefit has been dealt the same blow. It has also been stated by several legislators, and by Scully himself, that we will probably not see the expected 2003 relief on the 5.4% reduction to the conversion factor that was put in place in 2002. (This is in addition to another approximate 4% cut to the technical component in radiology in 2002.) In fact, the House and Senate adjourned before completing action on legislation that would have prevented the cut in physician payments next year. As frustrating as this situation may be, there is still a window of opportunity to get Congress to act before the end of this year. As it stands, both the Senate and the House are scheduled to return to Washington, DC, on November 12 for a lame-duck session, mainly to approve another continuing resolution, but possibly to pass some FY '03 spending bills. This lame-duck session will also be our last opportunity this year to get legislation passed to help physicians.

One other area that we are facing is the potential 2003 cut in positron emission tomography reimbursement that will deal a significant blow if it cannot be reversed. Several groups, including the Society of Nuclear Medicine, the American College of Radiology, and the National Coalition for Quality Diagnostic Imaging Services (NCQDIS), are focused on this issue and we need to support their efforts vigorously.

So what is the answer? Where is health care headed in the Bush agenda? It clearly is not up front; as we all know, it cannot be. We will move forward on HIPAA, but we see little else getting completed in the near term. The CMS focus on cost savings for Medicare will continue and, perhaps, even escalate as our tax base dwindles, and a potential for war exists. If you are not active in support of the several lobbying efforts in radiology in Washington regarding reimbursement, now is the time to consider taking a very active role for next year. In today's political arena, the squeaky wheel does get the oil. The radiology industry cannot sit quietly on the sidelines. We know how important radiology is in helping to keep down costs over the entire episode of care, but Washington does not live it like we do. It is imperative that they recognize it as well. That will not occur if we are not there, in front of the people who matter, with the facts to support our agenda. That takes data, information, and teamwork. If you have not been participating, I encourage you to find a way to get involved today. You will not be sorry.

Cherrill Farnsworth is the chairman and CEO of Health Help, Houston, a radiology management organization, and the president of the National Coalition for Quality Diagnostic Imaging Services (NCQDIS), Washington, DC, an organization that represents the interests of the radiology industry. The phone number for NCQDIS is (202) 872-6767.