Innovative, Pro-Patient MARCA Legislation Deserves Congressional Action
It would seem that any policy innovation that could lower healthcare costs, expand access, provide better care, and give much needed relief to overworked doctors in high-stress practices would be an easy sell. Yet sadly, legislation which would accomplish all of the above, the Medicare Access to Radiology Care Act (MARCA) now languishes in House and Senate committees like a dead letter.
To understand the importance of MARCA, it's helpful to know that radiology is one of the most intense and stressful medical practices, ranking extremely high in physician burnout, insomnia, chronic headaches, and numerous other health issues. MARCA would allow radiologists’ highly trained assistants (RAs) to take some time-consuming and patient-centered tasks off their plate so that the doctors can focus more on their primary duties of patient care.
The current problem is that the radiologists that supervise RAs are currently not permitted to bill Medicare for non-imaging patient management services and image-guided procedures. This includes such things as sitting with patients to ensure they understand procedures and diagnoses, injecting imaging contrast, or a host of other necessities of patient care. Excluding billing for these services is needless and inefficient, as RAs are fully licensed and highly qualified to conduct both imaging and non-imaging services under the supervision of a radiologist.
If Congress were to pass MARCA and allow radiologists to bill for these non-imaging services, we could achieve a healthcare hat trick – better quality, more accessible care, and lower costs.
As one indication of the value of RAs to a radiology practice, patient satisfaction scores consistently rise when RAs are able to engage more with patients on non-imaging services, largely because they are able to devote more time to patients and their families to educate them on procedures, side effects, follow-ups, and the like. This allows radiologists to spend more time on the things that only a radiologist can do — interpreting images, managing complex and urgent cases, and consulting with referring physicians. A collaborative practice between radiologists and RAs significantly reduces the chance for errors and professional burnout
As the number of Medicare beneficiaries increases, it is critical that specialties such as radiology keep pace in providing high quality care. This can be problematic for America’s rural communities that have faced a shortage of medical professionals for years, which the COVID-19 pandemic has only exacerbated. For non-critical access hospitals in rural areas that frequently have fewer than five radiologists on staff, radiologists employing an RA to perform non-imaging services would greatly help reduce wait times for procedures and initial consultations.
For example, MARCA’s billing structure could increase the availability of appointments for fluoroscopy and other minor procedures. The smaller facilities must limit the number of these procedures they can do each day to 1-2 hours per day because the radiologists need to spend most of their time interpreting images or other services they alone are qualified to perform. Under MARCA, facilities could make far more time available for these procedures with the RA, perhaps up to 6-7 hours a day.
There is an understandable assumption that adding a new health care provider like an RA will result in more Medicare billing and higher taxpayer costs, but the opposite is true. First, as a referral-based practice, radiology has no influence over those referrals, and because of current law neither radiologists nor the RAs who work for them can order medical imaging. Secondly, any non-imaging services an RA performs are done at 85% of the reimbursement rate billed to Medicare, a noticeable discount from the rate billed by a radiologist.
In simple terms, signing MARCA into law means those patients may be able to schedule their imaging procedures sooner than in the past and at 85% of the cost. Other than a radiologist or radiation oncologist, no other health care provider receives as much specialized training in radiology services and radiation safety than an RA.
MARCA unties the hands of RAs to perform medical services that patients need, while providing overworked radiologists the margin they desperately require. It will lead to greater access to patient services, higher quality care, and better patient outcomes without socking it to taxpayers.
Gerard Scimeca is chairman and co-founder of CASE, Consumer Action for a Strong Economy, a free-market oriented consumer advocacy organization.
