FISA fails miserably as a way to gather intelligence quickly

The Hill’s Sept. 25 story on Director of National Intelligence Adm. Mike McConnell (“Democrats question credibility, consistency of DNI McConnell”) unfortunately perpetuated a myth spread by partisan activists that an emergency order under the Foreign Intelligence Surveillance Act can be obtained “in minutes,” citing testimony of the committee by former Department of Justice official Jim Baker.

A quick read of the transcript from the hearing shows that Mr. Baker was very careful to clarify his statement, saying, “The emergency process, there are complications to it. I don’t mean to sit here today that you push a button, or it is not like click ‘buy now’ on the Internet. It does take time.” That time includes factual and legal investigations to make sure that the probable cause requirements mandated by the Foreign Intelligence Surveillance Act are fully met. The cumbersome nature of that process often prevents the intelligence community from operating with speed and agility.

There is no clearer demonstration that FISA fails miserably to allow intelligence collection “in minutes” than the inexcusable, hours-long delays in collecting information on insurgents involved with the kidnapping of American soldiers described by Adm. McConnell. We must ensure that the intelligence community can react quickly to prevent attacks instead of protecting the nonexistent legal rights of radical jihadists overseas.


Preserve Medicare funds for DXA imaging
From Andrew Laster, M.D., vice president, International Society for Clinical Densitometry

Your Sept. 12 article, “Medical imaging executives lobby White House advisers on Medicare payments,” highlighted congressional efforts to save Medicare dollars by reining in spiraling imaging costs through the Deficit Reduction Act. However, in the case of osteoporosis testing, the cost-cutting measures will have the opposite effect.

DXA (dual energy X-ray absorptiometry) is the gold-standard test used to diagnose and treat osteoporosis. The test is different from advanced imaging procedures and therefore was not an appropriate target of the DRA.

Indications for DXA testing are well defined and legislated. In addition, local Medicare carriers require specific diagnostic codes for reimbursement. As such, inappropriate use of the test is effectively prevented.

Despite appropriate increases in DXA volume, osteoporosis screening remains abysmal, with only 9 percent of qualified women tested in 2006.

With a median cost per test of $134, DXA is a relatively low-cost procedure. Unlike other advanced imaging services, DXA is most often done by primary care physicians as part of clinical preventive services that CMS promotes in the “Welcome to Medicare” exam.
The impact of the DRA cuts to DXA reimbursement is already being felt, as 37 percent of practices will eliminate this service by the end of 2007. When additional cuts take effect, dropping DXA reimbursement by 75 percent to $35 in 2010, nearly all practitioners in the office setting — 93 percent — indicate they will stop performing DXA for Medicare beneficiaries.

This reduced access to care comes as osteoporosis reaches epidemic proportions, with 1 out of every 2 American women sustaining a facture in their lifetime. Moreover, U.S. healthcare costs for osteoporosis are already at $16 billion per year and lead to more deaths annually than breast cancer.

A recent study by the Lewin Group estimates that freezing DXA reimbursement rates at 2006 levels would result in an actual five-year savings of $1.14 billion from reduced osteoporotic fractures.

Congress needs to act now to guarantee that all qualified women have access to DXA testing. Like mammography, which was exempted from the DRA, DXA testing should not be included with other advanced imaging services.

West Hartford, Conn.