Recent HCFA changes restrict healthcare access to Seniors!

jp jpannier at USAOR.NET
Sun Feb 8 08:57:36 EST 1998


Oct. 31, 1997 Federal Register: pg. 59060- HCFA changes restrict
healthcare access to Seniors

Recent changes to the HCFA regulations in the Federal Register will
cause undo hardship to Medicare subscribers, physicians
and healthcare providers. It is critical, to the ongoing delivery of an
integral component of a patients medical work-up, that this
regulation be stopped before all parties involved in these procedures
suffer unnecessary consequences. Changes were made in
the definition of the =91Supervision of Diagnostic Tests'. These changes
will shut down many facilities that can not comply with the
new ruling.

By changing the regulation to require direct supervision, we are
concerned that patient care will be compromised at an
extraordinary cost and thousands of jobs lost in the United States.

Currently, nursing home residents are provided electrodiagnostic and
ultrasound services by registered technologists, within the
nursing home facility. With the new regulation change, the resident will
now have to be transported to the nearest hospital at great
increase in cost to Medicare and participating insurance providers for
the transportation and increased procedure costs due to
point of service. The senior resident who was able to stay in the
comfort of their nursing facility previous to Jan. 1, 1998 and
choose to have his medical diagnostic procedures performed in-house, is
now forced to take ambulance transportation to a
hospital for those tests. The stress factor associated with leaving the
comfort of their facility for many seniors is so large they may
refuse to go for their testing.

Many seniors, not living a nursing facilities, prefer the convenience of
having their testing performed onsite in their primary care
physician's office. They will now be forced to travel long distances to
overburdened hospital departments.

Seniors in rural communities will simply be denied access to testing
unless they to drive long distances. Many rural hospitals and
clinics do not have the luxury of employing full-time neurologists nor
radiologists and therefore will be forced to cease providing
these diagnostic services. All out-patient/ambulatory-care facilities
are affected since they fall under Medicare Part =91B'.

Not only do these new changes drastically effect the availability of
diagnostic testing to seniors but, requiring direct supervision
for these procedures would only put small hospitals and other healthcare
providers at a severe competitive disadvantage, as well
as a significant loss of business without benefit to the patient. Having
the interpreting physician present in the exam room does not
assure quality. The protocol to which will accomplish the goals to
assure quality and proper utilization of diagnostic testing is the
accreditation process undertaken by national societies. This type of
process will assure the quality of the work product of both
the technologist and the physician who participate in the performance
and interpretation of these studies.

Teleradiology was initiated to increase the quality of patient care and
significantly decrease the costs associated with providing
the newest high-tech procedures. The most rural of facilities can now
provide the best services. But, teleradiology was addressed
in this HCFA ruling [pg 59062] and clearly stated that this does NOT
constitute supervision. Therefore the newest teleradiology technologies
may be there but, NOT AVAILABLE if the patient happens to be a Medicare

Does all this mean that once you reach age 65, you are forced to become
a medicare participant and therefore your choices are
now severely limited. Doesn't this violate the current discrimination

Seniors can no longer choose to have their diagnostic testing performed
where they wish for their convenience.

Seniors will now have to travel long distances if their 'local' facility
does not have a full-time neurologist nor radiologist to sit in the
exam room while tests are being conducted.

Seniors will not be able to choose if they would like to utilize
teleradiology services and have the interpreting physician of their

What has been accomplished for many years in an efficient and cost
effective manner will now be changed dramatically, causing
chaos and havoc, for the medicare patient, physicians, hospitals and
MEDICARE itself.

Medicare has not yet informed Seniors about the new restrictions.
Medicare has not yet informed the relevant healthcare
providers about the new restrictions.

This new ruling probably also violates federal restriction-of-trade
laws. Why does this only effect Medicare Part'B' providers.
This definitely puts all medicare Part'B' providers at a severe
competitive disadvantage. How many may be forced to close down
if a significant percentage of their business is Medicare? How many
thousands of registered diagnostic testing technologists will
be soon forced into unemployment because of the inability of facilities
to comply with the new direct supervision requirement.

I figured that this issue would definitely be of concern to you. I urge
you to do what ever you can to overturn this ruling. Your
forthcoming response is greatly appreciated.


Jeffrey W. Pannier, President
Mobile Medical Technologies, Inc.
jpannier at

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