The Alliance for Quality Medical Imaging and Radiation Therapy (Alliance), a group of 20 organizations of health professionals (including the American Association of Medical Assistants) representing more than 750,000 imaging technologists, radiation therapists, and medical physicists, is requesting that all of the 750,000 individual members contact their congressional representatives and senators and ask them to cosponsor the Consistency, Accuracy, Responsibility, and Excellence (CARE) in Medical Imaging and Radiation Therapy bill (S. 1042) and move the legislation to enactment.

 

To assist everyone in contacting members of Congress, the American Society of Radiologic Technologists (ASRT), a founding member of the Alliance, has opened the advocacy area of its website (www.asrt.org) to the public. By using the advocacy tools, which are normally only available to ASRT members, individuals can quickly identify their senators and representatives and find contact information to call or send an e-mail message supporting the CARE bill.

 

To further assist AAMA members in expressing support for the CARE bill, frequently asked questions about the bill adapted from the ASRT website are presented below. Also, see President’s Message in this issue to review a letter from AAMA President Linda A. Brown, CMA (AAMA).

CARE bill FAQs

What will the CARE bill do?

The CARE bill will amend and enforce the Consumer-Patient Radiation Health and Safety Act (CPRHSA) of 1981 (42 USC 10001, et seq.), and charge the Secretary of the Department of Health and Human Services to promulgate updated regulations specifying the education and credentialing requirements for persons who perform medical imaging examinations and who plan and deliver radiation therapy treatments.

Why is the 1981 CPRHSA unenforceable?

When the CPRHSA bill was on the Senate floor for the final vote, a political bargain was struck to ensure the bill’s passage and the enforcement mechanism was stripped out in an amendment. This law directed HHS to develop regulations specifying the education and credentialing of radiographers, radiation therapists, dental radiographers, sonographers and nuclear medicine technologists, but there are no legally enforceable penalties for states which chose not to comply by adopting the education and credentialing standards.

If there are federal standards in place why don’t states follow them?

Some states have chosen to follow the federal standards and have put state laws or regulations into place specifying the education and credentials for medical imaging and radiation therapy personnel; many state laws set standards significantly lower than the federal recommendations. States that have not followed the federal guidelines cite many reasons, including impasses in the state legislative bodies, lack of evidence supporting a benefit, states-rights and the nonapplicability of 20-year-old standards in today’s health care environment.

How will the CARE bill make the 1981 CPRHSA enforceable?

Looking at the bill it may appear that there isn’t much meat on it specifying educational and credentialing standards. This is because the bill amends the 1981 CPRHSA to make the law enforceable. The CARE bill makes it a condition of payment under all federal health insurance programs (Medicaid and Medicare) that medical imaging and radiation therapy personnel working in facilities receiving Medicaid/Medicare payments or working for physicians receiving Medicaid/Medicare payments must meet the federal education and credentialing requirements or the insurance claim for imaging or therapy services will not be paid. The end result is that medical imaging and radiation therapy professionals will have to meet the federal education and credentialing standards set by HHS.

How can we ensure that HHS will write “good” standards?

Once the CARE bill is passed, HHS is required by the Federal Administrative Procedures Act to publish in the Federal Register a notice called a Notice of Proposed Rulemaking. This is an opportunity for the public to comment on what they think should be included in the education and credentialing standards. The Alliance for Quality Medical Imaging and Radiation Therapy has been working on a comprehensive draft of updated education and credentialing guidelines to provide to HHS when the rulemaking process begins. This document will most likely be the document upon which HHS will base their education and credentialing standards. Other organizations may also make comments, but the majority of organizations who would normally make public comments on proposed education and credentialing regulations have already been working on the Alliance draft.

Will the CARE bill exacerbate the personnel shortage?

Even though medical imaging and radiation therapy professionals are in short supply in some areas, the CARE bill will not exacerbate the shortage. The CARE bill will ensure that all medical imaging and radiation therapy professionals meet educational and credentialing standards and specify a generous timeframe for states, employers and individuals to comply. Additionally, the CARE legislation gives the Secretary of Health and Human Services some latitude to issue alternative regulations based on defined criteria if needed to preserve patients’ access to care. As a historical perspective, a 1976 study conducted by the American Society of Radiologic Technologists and the American College of Radiology showed that mandatory state licensure had no significant effect upon technologist manpower in terms of recruitment, availability, or compensation.

What is the Alliance for Quality Imaging and Radiation Therapy?

The Alliance is a coalition of 18 organizations supporting the need for federal educational and credentialing standards for medical imaging and radiation therapy professionals. Founding members of the Alliance are the American Society of Radiologic Technologists and Society of Nuclear Medicine-Technologist Section. 

You state that the CARE bill will help the federal government save money. How?

The CARE bill will reduce health care costs by lowering the number of medical imaging examinations that must be repeated due to improper positioning or poor technique by requiring that personnel who perform medical imaging examinations meet educational and credentialing standards. Repeated imaging examinations cost the U.S. health care system millions of dollars annually in needless medical bills. According to the Radiologic Sciences Of North America journal Radiology, approximately 130 million diagnostic radiology procedures are performed on 30 million Medicare enrollees a year.1 Approximately $9.3 billion was spent by Medicare on medical imaging in 2003 (according to the Medicare Payment Advisory Commission MedPAC).2 If the national repeat examination rate is between 4 percent and 7 percent averaging 5.5 percent and the CARE bill can lower the repeat rate from 5.5 percent to 4.5 percent, enacting education and credentialing standards could save Medicare nearly $92 million a year.

In a nutshell, what are the standards?

The disciplines included and a synopsis of the Alliance-recommended standards for a limited X-ray machine operator (LXMO) are as follows:

These standards apply only in states that expressly license limited X-ray machine operators. Any state that licenses LXMOs must have standards that mandate completion of a LXMO educational program that meets the curriculum content specified in the ASRT LXMO curriculum or completion of a medical assistant program that meets the curriculum content specified in the ASRT LXMO curriculum and successful completion of an examination that meets the federal standard. LXMOs are limited to radiography of the chest and thorax, cranium, extremity, podiatric and vertebral column and are prohibited from performing procedures involving contrast media, fluoroscopy and computed tomography.

Questions? Contact Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org or 800/228-2262.