Medical imaging cuts in President Barack Obama’s budget proposal, which are projected to save $820 million over 10 years, have medical device industry lobbies gearing up for a fight.

David Nexon, senior vice president of AdvaMed, Gail Rodriguez, the newly installed leader of the Medical Imaging & Technology Alliance, and Tim Trysla, head of the Access to Medical Imaging Coalition, each told MassDevice.com that the proposal would restrict access to life-saving technologies, force imaging facilities in rural areas to close and raise costs.

One particular concern is a measure, prior authorization, that would require physicians to get Medicare’s approval for an imaging test ahead of time, AMIC’s Trysla told us. A 2009 review of prior authorization for medical imaging by the General Accounting Office featured comments from the Centers for Medicare & Medicaid Services that "they don’t believe there’s any independent evidence that these things really work," he said.

"They’ve highlighted the fact that this would actually cost the government – this is actually going to cost the government more money if it’s put in place. And those are the government’s words, not ours. We believe this would result in massive delays in care and access to care," Trysla said. "We think that this is not only a wrong-directed policy, but certainly not in the best interests of patients or Medicare."

The proposal would also set a new utilization rate, part of the complex formula used to calculate reimbursement rates. The new 90% rate posits that an imaging facility be in use 90% of the time – which is impossible in the real world, MITA’s Rodriguez said.

"A 90% utilization rate is almost physically impossible for an imaging center. It’s unreasonable. There’s just no way an imaging center can maintain 90%. That’s going to negatively impact payment to these imaging centers and hospitals," she said. "Raising that percentage to 90% will effectively put imaging centers out of business, especially smaller ones in rural areas."

The medical imaging industry is already feeling the pressure after a wave of high-tech innovation pushed it to new heights in the 1990s and 2000s. That success – and the accompanying increase in imaging procedure volumes – made the industry a target for Washington budget hawks, AdvaMed’s Nexon noted.

"Imaging became a target because it was growing quite rapidly at one point, but that growth has really slowed down," he told us. "We don’t think [the proposed cuts] are justified. Imaging has already been hit quite hard."

Rodriguez said the industry has already gone through 8 sets of cuts since 2006, sending the spending per beneficiary on diagnostic imaging down 13.2% over that period.

"This world has already taken a bunch of cuts since 2006," she said. "It’s going to affect jobs, it’s going to affect mortality. That means patients are not getting the imaging they need. It’s going to affect public health. Instead of cutting it further, we really need to think about increasing access."