Dan Anderson

Amid a hail of gunfire, medical imaging dodged a bullet.

President Bush, last month, proposed a $3.1 trillion budget for fiscal 2009, and, as expected, he wants to gut the Centers for Medicare and Medicaid Services (CMS). It starts with $16 billion next year, then progresses to $196 billion over the next 5 years. In the next decade, Bush has pitched a $619 billion reduction, a gutting of epic proportions.

By 2018, the mean age of Baby Boomers will be 63. As a tidal wave of people are about to be enrolled in government health programs, the government will have dramatically reduced its spending on health programs. But, at least for 2009, the government has backed off on the medical imaging community. Awfully nice of them, since they've already slashed $13 billion from imaging alone.

"The imaging industry has faced a significant impact in the [Deficit Reduction Act of 2005], and has, over the last year, felt the magnitude of those cuts," Andrew Whitman, vice president of the lobby group Medical Imaging & Technology Alliance, told me.

But don't breathe a sigh of relief just yet: Remember, this is the proposed budget. ‘Til the ink is dry on the president's signature, anything is possible. Because too much is not enough, more cuts to Medicare reimbursements are pending. Because Congress couldn't settle the proposed 10.1% cut last year, they simply begged off until June, when the same amount will be on the table—and then another 5% reduction at year's end. James Polfreman, who leads outpatient imaging for Texas' Hermann Health System and sits on the Imaging Economics editorial advisory board, has some thoughts on that scenario in this month's Last Word column. A word of advice: Don't read it before bedtime; you'll have nightmares.

The American College of Radiology (ACR) notes a disproportionate reduction in Medicare reimbursements when compared to those for managed care plans.

"If enacted, the significant reductions in payments to hospitals could have adverse revenue ramifications for physicians who work in or with hospitals," the ACR said in a budget overview. "Moreover, they could have unintended consequences for the nonhospital practice of radiology. The Deficit Reduction Act of 2005 capped technical component reimbursements for diagnostic imaging services provided in physician offices or freestanding imaging centers to the lesser of the amount under the Medicare Physician Fee Schedule or the amount under the Hospital Outpatient Prospective Payment System. Consequently, cuts to hospital outpatient updates could reduce imaging reimbursements in nonhospital settings."

By George, though, we'll all receive a $600 check from the IRS this spring. Don't get me wrong, I'm all for found mone. But the bucks to stimulate the economy aren't magically appearing and we have a good idea where some of that money is coming from. Wonder how many people will use their $600 to offset the cost of an MRI that's no longer covered?

We can all be happy that medical imaging wasn't in the sights of the budget planners in this first round. But hold on to your hats because this shootout is just getting started.

Dan Anderson
Editorial Director