This year already has proven to be a busy one for legislative activity in radiology. The heightened level of interest has to do with several key factors. With the presidential election approaching in 2008, health care and its funding will continue to be a hot topic for debate; and as medical imaging costs and utilization continue to skyrocket, radiology will remain in the legislative and regulatory spotlight. Some early 2007 national and state highlights follow.

The National Front

HR 1293 is the latest version of the movement to roll back the Deficit Reduction Act (DRA) of 2005 imaging cuts. The American College of Radiology (ACR) has worked with the Access for Medical Imaging Coalition to introduce the legislation. The bill currently has 59 cosponsors. The DRA rollback will be the focus when radiologists lobby their congressmen during the ACR annual meeting in Washington on May 23.

The Mammography Quality Standards Act (MQSA) is also up for renewal. MQSA is subject to congressional reauthorization every 3-5 years. The process gives stakeholders the opportunity to propose new or updated measures to assure the quality and access of breast imaging for all women. Although a specific bill has yet to be introduced, several topics likely will be addressed in forthcoming proposals, according to Josh Cooper, the ACR's senior director, government relations. Among them is elimination of the exemption for stereotactic biopsy units, expansion of MQSA oversight to other modalities such as MRI and ultrasound, mandatory self-assessment as part of the minimum CME requirements, and Quality Control (QC) manual standardization for full-field digital mammography equipment.

Several cancer screening bills have been introduced. HR 1132 (S. 624) would reauthorize funding for the National Breast and Cervical Cancer Early Detection Program, which has subsidized mammography exams, Pap tests, and other screening methods since it was enacted in 1990. The bill would increase authorized funding and allow states to apply for federal waivers to spend more on some hard-to-reach women that advocates say have been underserved. HR 1738 and HR 1624 make appropriations for colon cancer screening and treatment. HR 1030 proposes funding for cancer screening specifically for minorities and/or underserved populations

The House and Senate have cleared the Trauma Care Coordination bill (HR 727+S657). The bill would authorize $46 million over five years in grants to help states further develop their trauma networks.

Also, in its 2008 budget resolution approved March 29, the House included reserves for reauthorization of the State Children's Health Insurance Program, Medicare changes, and federal health care fraud and abuse prevention programs. The budget still needs to be reconciled with the Senate version.

Stateside Activities

In my home state, the Arizona Radiological Society committed to initiate self-referral legislation. A lobbyist has been hired. SB 1559 would impose Stark-type restrictions on referrals for commercial beneficiaries. We succeeded in getting the bill sponsored by the Chair and Co-chair of the Senate Health Committee. Due to the pressure and support of key legislators, the Arizona Medical Society has pledged to work with the Arizona Radiological Society in finding ways to address egregious forms of self-referral.

After this legislative session, we are planning campaign functions for supporters of the bill and other potential sponsors. The ARS will also be developing presentations for regulators, politicians, administrators, and representatives of the payer community to raise awareness of self-referral schemes.

Other states continue to focus on self-referral, as well. Texas has submitted Senate Bill 1101 that would require disclosure with self-referral, described as "disclosure on steroids". The intent is to gather data and evaluate the true economic impact of self-referral to serve as a basis for future legislation. Another bill proposed would require that only the physician who renders the official interpretation could bill for the service. As in the 2007 proposed rules, the bill would eliminate the arbitrage of collecting global charges and then subcontracting for professional services at less than CMS rates.

Maryland, New Jersey, and Texas have all seen radiology assistant bills introduced.  As you may remember, the ACR and the American Society for Radiologic Technologists, Albuquerque, NM, published a joint statement supporting the concept of RAs as opposed to RPAs. Last year, the ACR and the Florida Radiological Society worked together in getting meaningful RA legislation passed in that state.

In Virginia, an attempt to circumvent certificate-of-need (CON) requirements was successfully defeated. HB 2155 was proposed by a neurologist and would have created an "exemption" for any "equipment purchase" less than $500,000. Radiologists in the state organized an effective grassroots campaign and successfully argued that the provision would result in over utilization of sub-par equipment and reduce quality. Currently, there is a challenge in Connecticut for an exemption to the state's CON to allow ENTs to acquire mini-CT scanners and do sinus scans in their offices.

Some states are looking to tax health care providers for additional funding. Rhode Island has introduced legislation that would tax imaging centers 2%. California has proposed taxing providers 2% and hospitals 4% in order to help fund universal health care coverage. Recently, New Jersey and Connecticut averted attempts to impose similar taxes on providers.

Several interesting bills have also arisen in Minnesota and Iowa regarding pre-authorization. Iowa HB 833 would eliminate the need for pre-authorization if a health care plan covers the diagnostic test. Minnesota HF no. 2003 would impose a moratorium on health care plans from utilizing pre-authorization measures. It would also establish a "Diagnostic Imaging Services Advisory Committee" that would report to the legislature no later than July 1, 2008.

In Georgia, Senate Bill 102 aims to give chiropractors the authority to "use X-ray and refer patients for diagnostic imaging, neurodiagnostic studies, and laboratory tests," as well as give them the ability to perform physicals. The bill is currently in front of the state House of Representatives.

According to a report from the Denver Business Journal, Colorado became the first state to require health insurers to use a standard managed care contract when negotiating with doctors, dentists, and other health care providers. Senate Bill 79 marks a potentially landmark precedent in state government's involvement in commercial payor contracts. Supporters say it will reduce costs by creating clearer contracts and cutting down on administrative hurdles.

"Neither liberty nor property is safe when the legislature is in session."

—Edmund Burke

Federal and state legislatures continue to be active in health care and medical imaging. Especially with the DRA, we all recognize that our practices can change radically with the stroke of a legislative pen. Radiologists must be vigilant about political and regulatory activity in their local jurisdictions as well as in Washington. Grassroots efforts are the most effective: Everyone should get involved. Here are some ways you can make a difference:

• Contribute to RADPAC and your state chapters' Political Action Committees.
• Get involved in campaigns for candidates supporting radiologists' issues.
• Respond immediately to blast e-mails calling for legislative action. These are often time-sensitive due to pending votes. Do not procrastinate. Get your voice heard.
• Get to know your local and federal representatives. Establish credibility by becoming a reliable resource for health-related issues.

As a specialty, we must work to raise the political awareness of our partners and residents. Accept that lobbying and influence are important components of the political process. As James Madison stated, "Self-interest is the engine of the government."