Effort to Prevent PET Cuts
This summer, the Centers for Medicare and Medicaid Services (CMS) proposed drastic payment reductions to myocardial PET scans delivered in the physician office setting. In response, ASNC quickly mobilized and delivered to CMS officials a strong defense, led by ASNC member Randy Thompson, MD, for fair and accurate Medicare payments for cardiac PET.In the weeks that followed, hundreds of ASNC members joined the fight to protect cardiac PET by answering ASNC's “calls to action.” You explained to CMS the cost of making cardiac PET accessible to patients, and you let your members of Congress know that steep reductions in Medicare reimbursement for cardiac PET will greatly disadvantage patients and dampen interest in discovering new applications of this important technology.
On behalf of ASNC, I thank each and every person who took action.
As a result of your advocacy and the strong leadership of your ASNC in partnership with the American College of Cardiology, the American College of Nuclear Medicine, the Cardiology Advocacy Alliance, and the Society of Nuclear Medicine and Molecular Imaging, 43 members of the U.S. House of Representatives, led by Reps. Mike Kelly (R-PA), Ron Kind (D-WI) and Ron Estes (R-KS), sent a letter to CMS asking that the Agency “work with stakeholders to improve the accuracy of equipment inputs when calculating PET reimbursement.”
Your ASNC was also successful in securing another letter to CMS from Reps. Christopher Smith (R-NJ) and Joyce Beatty (D-OH), co-chairs of the Congressional Heart and Stroke Coalition. In their letter, Reps. Smith and Beatty underscored that payment cuts of the proposed magnitude would be disruptive to physician practices and could harm patient access to the technology.
This multi-pronged advocacy effort also included formal comments from ASNC to CMS that benefitted from the expert advice of ASNC's Health Policy Committee under the leadership of David Wolinsky, MD, and Bill VanDecker, MD.
In its letter, ASNC recommended to CMS that cardiac PET be paid using the most recent contractor priced claims data (2018) for 78459,78491,78492 (using the weighted average) in the physician office and independent testing facility setting. This approach would keep payment rates stable in 2020 and allow stakeholders the opportunity to provide CMS additional information on equipment costs.
CMS will consider these and other comments it received by the September 27 deadline as it decides whether to finalize cardiac PET rates as proposed or adopt an alternative payment policy. A final rule is expected on or around November 1, at which time ASNC will assess next actions.
Should you have any questions about the proposed payment reductions or to provide equipment invoices that can be confidentially shared with CMS, please contact Georgia Lawrence, at email@example.com.
Rob Beanlands, MD, MASNC