Licensing proponents call for federal intervention
Wednesday, September 29th, 2010
States’ disparate regulation of medical X-ray operators has not gone unnoticed by the federal government. Though Congress addressed operator training standards in the 1981 Consumer Patient Radiation Health and Safety Act, the unenforceable “recommended guidelines” did little to improve safety. Since then, the federal government has tried to close the gap by passing the Mammography Quality Standards Act in 1992, which set standards for individuals administering mammography exams. But officials say one unintended result of the Act is that it shifted resources away from the regulation of other types of diagnostic imaging.
The quality of care should be the same no matter what type of diagnostic exam is performed, said Jay Hicks of the Joint Review Committee on Education in Radiologic Technology.
However, the 2008 Medicare Improvements for Patients and Providers Act included provisions requiring minimum standards only for operators of “advanced imaging techniques,” such as CT scans, PET scans and MRIs, beginning in 2012. The bill applies to independent diagnostic testing facilities and physician offices, but not to hospitals. The measure also excluded X-rays, which is the most common imaging tool available.
Efforts to extend a similar provision to X-rays are under consideration in the House. The legislation wouldn’t force states to license, but it would mandate that operators meet certain minimum educational and training standards before Medicare will reimburse facilities or doctors’ offices for X-ray exams.
Improved training decreases the likelihood that an operator has to perform the same X-ray exam more than once, which in turn decreases health care costs, say licensing proponents.
Medicare pays for repeated imaging services, reducing only a portion of the reimbursement by 25 percent when multiple tests of the same kind are performed on the same patient during the same session, according to the Medicare Payment Advisory Commission.
Medicare spending for imaging services reached approximately $11.7 billion in 2008, the Committee reported. The national repeat examination rate is about 6 percent, but licensing proponents say enacting education and credentialing standards for technicians could reduce that rate to about 5 percent and save Medicare about $100 million.
Federal legislation failed each of the past 10 years, but the fate of this year’s bill may be different. During a Congressional hearing on Feb. 26, Chairman Frank Pallone Jr., a New Jersey Democrat, and other members stressed the importance of national standards given the extent to which state licensing requirements vary.
State regulators surveyed by the Workshop reported mixed feelings about the federal legislation. Regulators in Massachusetts and Illinois say the Constitution guarantees them the right to oversee public health and that their states are holding X-ray techs to the highest standards already.
Others fear the repercussions of federal regulations on existing state programs. Federal regulations without provisions for limited licenses would affect critical access facilities in Montana, said Helena Lee of the state’s professional licensing bureau. She can’t get fully licensed techs to work in rural Montana: “It’s like asking them to go to the moon.”
The impact of inconsistent standards may never be known. The FDA has stated, “If patient doses are higher than the expected level, but not high enough to produce obvious signs of radiation injury, the problem may go undetected and unreported, putting patients at increased risk for long-term radiation effects.”
The FDA is working with the Centers for Medicare and Medicaid Services on a new initiative to reduce unnecessary radiation from medical imaging, specifically CT and fluoroscopy exams. A timeline for implementing changes has yet to be established. According to the FDA's Dick Thompson, the agency is still developing its next steps and hopes to have something prepared for public comment before the end of the year.
