Industry experts offer various perspectives on what radiology can expect from health care reform.
On June 28, the Supreme Court officially upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). A key provision of the bill at issue was the individual mandate, which will require nearly all American citizens to obtain health care insurance by 2014 or pay a penalty. So how will the individual mandate—and all aspects of health care reform for that matter—affect radiology, specifically?
Well, there are various thoughts and theories being bandied about in the industry. Some experts say radiology better brace itself for far greater demand. For example, a recent study conducted by Regents Health Resources found that in some areas of the country the imaging community may not be equipped to handle the influx of previously uninsured patients who will soon require services. Brian Baker, president of Regents Health Resources and National Imaging Network, told Axis Imaging News, “Our fear, when we look across the country at imaging providers, is that with this onslaught, many of the states and providers could not handle the additional volume. Some because their technology is older, perhaps incomplete, and some because their processes may need to change and become more efficient.”
Other experts focus on the bottom line, noting that the increased number of insured patients will counterbalance decreases in imaging reimbursement. That sounds like a good thing for radiology, especially in light of CMS’s recent proposed rule to apply the multiple procedural payment reduction (MPPR) of 25% to the professional component of advanced imaging procedures provided by one or more physicians in the same group practice furnishing services to the same patient on the same day.
And still other experts, such as Cynthia Moran, assistant executive director, Government Relations, Economics and Health Policy at the American College of Radiology, say it is way too early to tell what kind of impact health care reform will have on radiology. “Health care reform’s effect on radiology really hasn’t been determined yet,” she said. “We do know that the Affordable Care Act is encouraging use of primary care and almost disincentivizes specialty medicine.”
Moran talked with me about some of what we can expect from reform as well as about the unknowns. “There will be less duplication of services and less unnecessary testing; we will see this,” she said. “Payors are making it clear that there will be penalties for using specialists. They incentivize the primary care physician to keep the patient within their range of care.” This may mean by not referring patients on for advanced imaging. “It might be more difficult for patients to get access to radiologists,” she said.
The real effect on radiology will be determined by how health care is evolving, according to Moran. The general themes that will continue to impact the profession include “more coordinated care; more bundles of services; more metrics-driven, quality care.” We can expect systems that are dominated by primary care and physician extenders. And Moran sees a critical and exciting role for radiology in all of this. “Radiologists can be an integral part of these systems that call for coordinated care,” she said. “We have the tools —decision support, appropriateness criteria—and can walk the physician assistant, nurse practitioner, and primary care doctor through how all of this works.”
According to Moran, the radiology community’s main goal right now should be to “convince payors and government policymakers that our services are valuable and cost-saving in their totality. When you prevent unnecessary surgery, you save a lot of money.
“I think the need for radiology will grow,” she said. “With all of the changes going on, radiologists have more going for them than any other specialty.”
Marianne Matthews
Editor
