ASNC speaks to members of Congress about major trends in cardiology

Fourteen American Society of Nuclear Cardiology (ASNC) members traveled to Washington, D.C., on June 3, participating in more than 40 meetings with members of Congress and their staff to try and explain the impacts of major policy issues impacting cardiology and nuclear imaging.

Proposed tariffs on radiopharmaceuticals, prior authorization policies and Medicare cuts were just some of the subjects they discussed.

Concerns that tariffs on radioisotopes would devastate nuclear imaging

The advocacy effort also included targeted meetings on the Commerce Department's section 232 investigation, which will result in recommendations to the Trump Administration on potential tariffs on radiopharmaceuticals. The ASNC team, led by ASNC President Panithaya Chareonthaitawee, MD, and Rupa Sanghani, MD, explained the fragility of the U.S. radiopharmaceutical supply and asked that any tariffs on these agents be deferred, at least until a domestic source is established.

Currently more than 70% of nuclear imaging in the U.S., including all cardiac SPECT scans, rely of isotopes produced overseas with no domestic production. While the federal government has been working to help foster domestic production for more than a decade, those efforts have fallen short.

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Prior authorization increases healthcare costs

Chareonthaitawee and ASNC Immediate Past President Lawrence Phillips, MD, moderated a panel discussion on prior authorization issues to explain the impact to lawmakers. Meeting in the Senate's Kennedy Caucus Room, Phillips asked the panelists to comment on why there is a perception among many physicians that prior authorization requirements have become worse, not better, over time. Some of the reasons panelists suggested included payers' increasing reliance on artificial intelligence (AI) and predictive technologies for authorization review and claims. The panelists and ASNC representatives emphasized the need to codify rules the Centers for Medicare and Medicaid Services (CMS) has established to streamline processes and increase transparency.

"Prior authorization increases practice cost, increases administrative burden and undermines patient care. I hope they remember our message when voting on upcoming legislation," ASNC member Suman Tandon, MD, of St. Francis Hospital and Heart Center, and ASNC's representative to the American Medical Association’s House of Delegates (HOD), said in a statement.

Prior authorization often causes unnecessary patient care delays. Insurance companies often deny authorization, knowing if often will not be appealed. While these appeals often overturn denials for care, it eats up a lot of provider time rather than focusing on patient care, and health systems spend a lot of resources on this process while many are already operating on thin margins. ASNC members said clinical decision-making is based on years of knowledge, experience, guidelines and research data. Most importantly, it is individualized for each  patient so one-size-fits-all insurance doctrine does not fit with today's clinical practice. They said care cannot just be reduced to an algorithm.

Congress is also looking at reinstating the appropriate use criteria (AUC) mandate for Medicare payments, which ACSN strongly opposed in the past before this provision was completely dropped in 2024. She said ASNC was firm in its discussions that AUC adds similar administrative burdens on physicians.

ASNC leaders urged members of Congress to oppose the recently introduced Radiology Outpatient Ordering Transmission (ROOT) Act (S. 1692), which would revive the Medicare AUC program for advanced diagnostic imaging.

"We had a productive day as an ASNC team establishing relationships with health specialists at the offices of our senators and representatives. We made good progress showcasing the importance of transparency with prior authorization, the disadvantages of appropriate use mandates, and the need for comprehensive physician payment reform," Jamieson M. Bourque, MD, with University of Virginia, said in the same statement.

Desperate need for Medicare reforms

ASNC representatives focused on issues where specific actions undertaken in the near term may positively affect physician practices and patient care. In addition to prior authorization, ASNC asked members of Congress to support the Improving Seniors' Timely Access to Care Act (S. 1816 | H.R. 3514) and the Reducing Medically Unnecessary Delays in Care Act (H.R. 2433).

ASNC also requested support for a permanent annual inflation adjustment tied to the Medicare Economic Index (MEI) and passage of the Medicare Patient Access and Practice Stabilization Act (S. 1640 | H.R. 879), which would stop the 2.83% Medicare physician pay cut that took effect Jan. 1, 2025, and provide physicians with a positive update for the rest of the year. 

In addition, members of Congress were asked to address Medicare payment site-neutrality. Current policy favors hospitals with higher payments, even though outpatient facilities can usually offer the same level of care at a lower cost. This policy is often cited for helping drive up healthcare costs when a lower-cost alternatives exists.

ASNC said these bills will support continued patient access to care through physician payment adequacy.