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Call to Action: Nuclear Medicine Reimbursement

September 29, 2015

The Centers for Medicare and Medicaid Services (CMS) has proposed changes to the nuclear medicine Ambulatory Payment Classifications (APCs) in its 2016 proposed rule for the Hospital Outpatient Prospective Payment System (OPPS). The Society of Nuclear Medicine and Molecular Imaging (SNMMI) believes the proposed rule will exacerbate an already existing nuclear medicine reimbursement problem that is impacting patient access and innovation.

Recognizing some of the emerging concerns, SNMMI created an APC Remodeling Task Force, which has spent the last 1½ years collecting and analyzing data and developing a proposal in collaboration with other nuclear medicine stakeholders. In January, an SNMMI delegation met with CMS and shared the proposal, which is broadly supported by other stakeholders including patient groups, manufacturers and medical societies. The SNMMI proposed payment methodology more accurately reflects the cost of all diagnostic radiopharmaceuticals and procedures used in the hospital outpatient setting.

We must urge CMS to withdraw the current proposed language and re-evaluate the proposal put forth by SNMMI. To that end, we have leaders in both the U.S. Senate and U.S. House of Representatives who are circulating a Congressional sign-on letter. The letter urges CMS to withdraw the current proposed language and re-evaluate the proposal put forth by the SNMMI.

We need your help! Please contact your Representative and Senators from your state and urge them to sign the Congressional letter being circulated by October 7th. When you contact your member of Congress, please tell them to contact the following Congressional staff:

Sarah Johnson - Senator Portman (R-OH)
sarah_johnson@portman.senate.gov

Katie Campbell - Senator Donnelly (D-IN)
katie_campbell@donnelly.senate.gov

Andy Flick - Representative Moulton (D-MA)
andy.flick@mail.house.gov

Helen Dwight - Representative Brooks (R-IN)
helen.dwight@mail.house.gov

Please view our background document on the issue and SNMMI's solution to the problem. Feel free to share this document.

In your email, please share where you work and where you live. Some employers have policies against sending letters with their names included, so please check with your employer in advance of sending your email. It is essential that you ask your Representative and Senator to sign the letter and also to provide any local examples of delays in care, patient access, or patients receiving alternate or inappropriate tests.

If you do not know your representatives, visit the House of Representatives website and the Senate website to identify your member of Congress. U.S. Postal Service mail to your representative must be scanned for security purposes, which adds additional time for delivery—so instead, please send emails. We need to act quickly to make a strong impact in favor of change. The Congressional sign-on letters will be sent to CMS by the second week of October.

If you have any questions, please do not hesitate to contact SNMMI’s Health Policy and Regulatory Affairs department at hpra@snmmi.org.