Statement of Timothy M. Bateman, M.D., Chairman, Government Relations Committee,
American Society of Nuclear Cardiology, Kansas City, Missouri

The American Society of Nuclear Cardiology (ASNC), a 4,500 member professional society dedicated to education and quality clinical excellence in the delivery of nuclear cardiology services, is pleased to submit its views on proposals to revise Medicare’s payment methodology for drugs being considered by the Ways and Means Health Subcommittee.

ASNC believes that solutions proposed for reforming practice expense reimbursement in administering cancer drugs may have an unintended, extremely severe adverse impact on continued patient access to many important services. The Society is particularly concerned that many patients who need diagnostic tests for cardiovascular disease may not receive those tests resulting in the unnecessary expenditure of millions of dollars at a later date. Heart disease remains the leading killer of both men and women. Testing by nuclear cardiologists to ascertain the existence of cardiovascular artery disease has led to reduced incidences of death from heart disease. This progress could be reversed by unwise legislative decisions. The Society is particularly concerned that while the subcommittee corrects one problem, it could create unintended burdens for many specialties including nuclear cardiology. ASNC requests that the Ways and Means Health Subcommittee include statutory language in any legislation it approves related to a readjustment of practice expense payments to physicians that would ensure that payments for services with no physician work component ("Zero Work Pool" services) are not reduced as a result of the subcommittee’s action related to the adjustment of practice expense payments for medical oncology services.

Medicare's method for determining payments for practice expenses for physicians' services is extremely complex.  In addition to the specialty-specific payment "pools" that exist under the Medicare payment system, there is a pool reserved for a group of technical component-only services (i.e. services for which there is no physician work component) provided by a number of different specialties.  Many of the medical oncologists' procedures reside in this so-called "Zero Work Pool" (ZWP), along with other capital-intensive procedures for specialties such as diagnostic radiology, radiation oncology, nuclear cardiology, nuclear medicine, echocardiography, and others. In 2002, services in the ZWP experienced a 4-6 percent cut in practice expense payments due to relatively minor shifts in the mix of services shown in the utilization data.  These cuts, combined with the 5.4 percent reduction in the conversion factor for 2002, equaled a 10 percent or greater loss in reimbursement for those services.  Since publication of the 2002 Physician Fee Schedule, specialties affected by these cuts have worked together, and with the Centers for Medicare & Medicaid Services (CMS), to determine why the losses occurred, and to ensure that similar cuts do not occur again in the future.

Today’s hearing examines proposals for changing methodologies of reimbursing chemotherapy drugs and practice expense payment methodology for chemotherapy administration. Should the subcommittee modify the practice expense payment methodology for chemotherapy administration, clinical oncology services could be removed from the ZWP. This modification potentially could have a devastating impact on those specialties that remain in the ZWP. The mix of services in the pool which changes based on each year's utilization data, significantly affects the amount of money allocated to the entire pool.  Since chemotherapy administration is among the most frequently performed services in the ZWP, the removal of these services would have a significant negative impact on the remaining specialties in the pool.

Technical component services are the foundation of many of the specialties in the ZWP.  The decreased Medicare payments—compounded by decreases from many insurers that base their payments on the Medicare Fee Schedule—will adversely affect the ability to provide care using the newest and most advanced technology to detect CAD that is now available. In the long term, without sufficient practice expense reimbursement, future research and development will slow as pharmaceutical and device manufacturers see that their customers are unable to afford their products.  The net effect of all these cutbacks will be reduced patient access to quality care.  These problems must not be exacerbated by inadvertent reductions that could result from revisions in payment methodology for medical oncology services.

The American Society of Nuclear Cardiology requests that should the Ways and Means Health Subcommittee address practice expense payments for chemotherapy administration legislatively,  that it do so in a manner that protects the practice expense payments for all medical services remaining in the ZWP from further inappropriate reductions.