Sometimes you receive such shocking, unmerited news that you can’t sit idle, and on July 27, 2019, we had just the reason to form a collective mission to save Cardiac PET. No one should ever doubt that a group of concerned citizens can change the world because it’s the only thing that ever has.
Cardiac PET was evaluated over that summer by the Centers for Medicare (CMS) and the American Medical Association (AMA) by what is called the RUC (Relative Utilization Committee). They receive inputs from providers as to the cost of equipment and labor and throw it into a calculation that generates your reimbursement (we’re simplifying just a bit). Due to this, the proposed PET 2020 reimbursement was reduced by 80%; again, keep in mind, this was a proposal.
Those utilizing this technology were dumbfounded. How could the future of PET myocardial perfusion imaging be under fire when it’s an essential and proven test for patients nationwide?
That month the Cardiac PET Industry Coalition (CPIC) was established. Partnerships formed among physicians, patients, vendors, and competitors alike. Banded together, those industry partners, shook things up.
The CPIC partnered and advocated to help combat the cuts to keep cardiac PET a viable imaging modality. We voiced our concerns to Congress and Centers for Medicare and Medicaid Services. We amassed an enormous volume of responses through advocacy messages and personalized letters sent by physicians and patients directly to decision-makers.
Patients got involved too, expressing their thoughts:
“This great diagnostic tool saved my life.”
“My wife had a PET stress test last August; it exposed a 99% blockage.”
“I wouldn’t be here today.”
“This test saves lives.”
“Of all things for Medicare to cut, this should be one of the last.”
To remove over 70% of patient access to cardiac PET seemed unjust, and yet here we were trying to prove a point that everyone seemed to know except those that proposed the actual cuts. Cardiac PET imaging is effective (high diagnostic accuracy), safe (low radiation exposure), efficient and patient-centered (accommodates ill or high-risk patients as well as those with large body habitus), provides equitable (independent of patient characteristics and condition) timely care, and produces cost savings for insurers and beneficiaries.
The CPIC worked closely with societies, key legislators, and healthcare providers since the onset of the issue to fully understand and formalize a correction while generating national awareness. We kept the advocacy fires burning while waiting for the final ruling.
The 2020 Medicare Physician Fee Schedule (MPFS), released on November 1, 2019, reversed a Centers for Medicare & Medicaid Services (CMS) proposal that would have reduced patients’ access to PET services and disrupted cardiology practices. CMS will not finalize its proposal that would result in payment reductions as high as 80 percent for the technical components of PET services provided in the physician office. Instead, the MPFS maintained contractor pricing for the technical component of these services while accurate data is collected and analyzed. CMS also adopted a 50% utilization rate for PET cameras, instead of the 90% that was assumed.
Our collective mission is still unfinished. We remain steadfast and resolute in our beliefs with how this modality saves lives and healthcare dollars. It is self-evident that we will always need to keep a watchful eye over those that would otherwise threaten the ongoing expansion of this incredible technology. Please stay vigilant with us, your partner, to stand for our professions and the patients we serve. We will continue to have a voice as we move forward to ensure this technology remains central in the efforts to treat and manage cardiovascular disease.
Our deepest gratitude surrounds those who; beat on the comment doors, voiced their concerns, wrote to their local and state officials, contacted their congressman and state representatives, inked the forty-three congressional signatures, arranged dinners, attended meetings and conferences, utilized press and social media exposure, provided unwavering support, and had never-give-up attitudes. We’re so very proud to be associated with all of you!