AAA Screening, Vascular Imaging--SVS Raises Concerns for Full Access

BY MARK S. LESNEY

WASHINGTON -- Medicare is "sinking" in terms of physician reimbursement Dr. Robert Zwolak told the Society for Vascular Surgery Health Policy Committee. The committee held a retreat in late September to discuss the political needs of vascular care.

Dr. Zwolak said that there are annual threats of deep cuts to physicians, historically staved off with smaller cuts or no growth from year to year, whereas hospitals and inpatient-care continue to receive a growing share of funds allocated. This coming year physician will see a 10% across-the-board pay cut unless Congress acts in the next few weeks. Other critical issues were the cuts in funding for vascular imaging that were mandated by the Deficit Reduction Act (DRA) of 2005 and the growing problem of suboptimal participation in abdominal aortic aneurysms (AAA) screening authorized by the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act.

Dr. Zwolak, chair of the Health Policy Committee, pointed out the importance of the SVS in dealing with government and regulatory issues. He said that on the regulatory side "we have worked with CMS for many years, but our work on legislative issues has become increasingly more important over the past 5-7 years." The effort started in 1999, with the SVS going to Capitol Hill to get specialty society data added to Congressional consideration on practice expense along with the more general data presented by the American Medical Association, he said. And the most recent success, of course, was the AAA screening effort which was passed in 2005--"a huge victory."

But there were concerns. With regard to SAAAVE, Dr. Zwolak said that he expects data from 2007 to show that there has only been a modest uptake of AAA screening because it is limited to those who undergo the Welcome to Medicare physical and "we need to expand AAA screening to the entire at-risk Medicare population. Congress earmarked $200 million over 5 years for AAA screening, and we're not going to come even close to using that. Before the money evaporates we need to go back to the Hill."

Another concern of the committee is with the cuts in imaging reimbursement that were introduced as part of the DRA.

Supporting the SVS position, Rep. John Shimkus (R-Ill.) and Rep. Gene Green (D-Tex.) sent a joint letter to the Centers for Medicare and Medicaid Services requesting exemption of vascular studies from the DRA cuts and are cosponsors of the 2007 Access to Medicare Imaging Act. The House version would permanently exempt ultrasound from cuts.

Both Rep. Shimkus and Rep. Green addressed the committee. They were two key sponsors of the SAAAVE Act in 2005 that initiated AAA screening as part of the Welcome to Medicare process.

In his talk to the committee, Rep. Shimkus discussed his frustrations with the bureaucracy and the cuts that occurred as part of the DRA. When asked about the physician's pay cut in Medicare, Representative Shimkus said that Congress would undoubtedly provide the last minute "Band-Aid" to prevent the proposed drastic cuts as usual.

In regard to the success of the SAAAVE Act, Dr. Zwolak informed Rep. Shimkus about the problem of linking the AAA screening to the Welcome to Medicare physical. "I wanted to put you on notice that we are going to be knocking at your door trying to get an expansion of AAA screening to cover the broader spectrum of people at risk." This risk group was primarily 65- to 75-year-old male smokers.

One of the issues raised during the committee discussion was the unfortunate necessity for Congress to find the money to pay for removing ultrasound from under the DRA with the Democratic majority supporting the concept of "pay-go" which means essentially, pay as you go for new programs.

With respect to the financing issue, one committee member stated that "ultrasound has got to be presented as an effective alternative to the more expensive imaging--that we have to make that clear. One test [ultrasound] costs a small amount, and if you don't have access to that you are spending five, six, seven times more for something that you get the same information from. And I think that point has to be driven home."

The committee also discussed results from an SVS survey conducted last fall of 187 physicians with office-based vascular labs. The majority of respondents believed a decrease in Medicare reimbursement would lead to as significant reduction in their ability to provide vascular diagnostic studies through closing of facilities, delayed purchase or upgrade of equipment, or personnel reductions. Although the committee recognized the difficulties of interpreting such surveys scientifically, they agreed that such cuts would have a real impact on patient care.

The morning meeting coincided with congressional site visits by SVS committee members in the afternoon to discuss the key issues with their respective senators. An added discussion of the meeting and a photo gallery are available at www.Vascularweb.com