Last week I blogged about CMS's decision to not cover "virtual colonoscopies," which use CT imaging to look for precancerous polyps. I wrote about it as part of a discussion of Medicare governance, and how to protect evidence-based decisionmaking from political interference.

Speaking of which: here is a letter from 57 members of Congress expressing their opposition to "arbitrary" cuts and coverage decisions about medical imaging. (The text doesn't mention virtual colonoscopy explicitly.) We've also seen a lot of print ads recently in Washington-focused publications about medical imaging.

What's peculiar about the cosigners of this letter is that there's no rhyme or reason to their political stripes or geographic location.  There's libertarian (Ron Paul), conservative (Patrick McHenry, Marsha Blackburn), moderate Republican (Mark Kirk, Frank LoBiondo), moderate Democratic (Dennis Moore, Jason Altmire), and liberal (Tammy Baldwin, Eleanor Holmes Norton) members on the letter.  The House Committee on Energy and Commerce, which controls physician payment, is well represented on the letter; House Ways and Means members, who control most other parts of Medicare, are mostly absent.

The letter also claims that every $1 spent on imaging results in $3 saved to the health system.  There are two branches of thought on this. 

As I blogged on earlier this year, one-third of CT scans are not justified by medical need, yet the number of CT scanners is still increasing. In U.S. cardiology practices the number has tripled in the past two years.  GoozNews points out the claim that CT scans can cure 80 percent of lung cancer by catching tumors early, but notes that this finding has been strongly criticized and the study's funding has been linked to the tobacco industry.

On the other hand, former New America colleague and neurosurgeon Guy Clifton in his book Flatlined relates how a primary care physician practice, the Sumner Clinic in Tennessee, has paired solely with one Medicare Advantage (MA) company, HealthSpring, to improve quality and reduce hospital admissions and ER visits.  This strategy has resulted in an increased use of imaging technology in this practice. However, the key difference between the Sumner Clinic-HealthSpring relationship and regular fee-for-service Medicare is that Sumner and the MA plan are acting like a de-facto Accountable Care Organization.  They assume risk for their patients and are encouraged to provide high-quality care.  They are not paid an additional fee for each additional scan.  

HealthSpring pays physicians a 20 percent bonus over standard Medicare rates if they reach 90 percent compliance on twenty-five quality measures.  Care is being provided at Sumner for 69 percent of the usual Medicare  payments (and by the current law governing Medicare Advantage, patients must see those savings through extra benefits or lower premiums).  These patients are healthier, their care is more cost-effective, and they spend less time in the hospital compared to most Medicare beneficaries.  

While I'm sure some of the lawmakers and staffers who worked on this letter are highly educated on matters of health care policy, I am skeptical that all fifty-seven members and their staffers are fully versed on the nuances of imaging -- the relative costs and benefits of, say, virtual colonoscopy over the traditional method. To be honest, I don't think Members of Congress should be making medical coverage decisions on this level.  It should not be part of the job.  Their job should be to ensure that Medicare is financed adequately and that beneficiaries have access to quality health care -- in other words, that the overall system works.  A body such as MedPAC or health care "Guardians" would be better suited (and more immune to political pressure) to review the science behind this detailed aspect of medicine.