A year-end gift list for the deserving

Cheryl Proval

Within weeks, we will close the books on a very challenging year in imaging, and begin anew, albeit facing many of the same issues radiology struggled with last year. And they are not trivial issues. Outpatient imaging was hit with severe reimbursement cuts, up to 40% for some studies. The sustainable growth rate factor mandates a 9.9% negative update of the 2008 Medicare Physician Fee Schedule (MPFS). And this occurs against a fairly dismal backdrop of impending trouble in the Medicare program, which faces financial difficulties as early as 2012, when the CMS will need to begin dipping into its trust fund. The fund itself is invested in US Treasury bonds, and the US Treasury is mired in unprecedented debt.

But…the holidays are here. Even if the end is nigh, that is enough of this talk. Bring on 8 days of gifts and a sleigh full of surprises. I have added the following to my gift list:

Congress: 535 New Pairs of Glasses to Correct Astigmatism
It is in the national best interest that Congress recognize and understand the potential of medical imaging to lower the cost of health care, lest it get any bright ideas about funding the fix for the 2008 MPFS with further imaging cuts in a DRA II. The cuts to image guidance in outpatient interventional radiology were particularly short-sighted.

CMS: A Boy Scout Handbook
The proposed 2008 MPFS makes strides in tightening the Stark law self-referral loopholes by disallowing per-click leases and invoking the antimarkup provision. Let’s hope the agency knows how to tie a surgeon’s knot.

Chicago Attorney General: A Life Jacket
Chicago Attorney General Lisa Madigan really missed the boat when she failed to name referring physicians in her complaint, instead naming the 20 imaging centers that engaged in leasing arrangements allegedly illegal under Illinois law. Cook County Circuit Court Judge Peter Flynn sent her back for specific allegations against each of the named centers.

Leonid Hurwicz, Eric S. Maskin, Roger B. Myerson: An Assignment in Health Care
Now that these gentlemen have won the Nobel Prize in economics for having laid the foundations of mechanism design theory, perhaps they would consider applying their principles to a perfect laboratory for this theory: a health care fix. Mechanism theory provides a coherent framework for analyzing the great variety of markets and conditions in which economic transactions take place, with a focus on problems associated with incentives and private information. Go ahead, fellows, give that theory of yours the acid test.

Regina Herzlinger, PhD: A Megaphone
Herzlinger’s case for consumer-driven health care provides a happy alternative to the single-payor health care system that many believe is the inevitable solution to the growing problem of the uninsured in America. She argues convincingly in her new book, Who Killed Health Care?, that an educated and empowered public can transform demand and supply in health care to create a more effective and efficient system.

Paul Berger, MD: A Leather-bound Edition of Current Procedural Terminology 2008
The CEO of Nighthawk Radiology, Coeur D’Alene, Idaho, already has a crystal ball. His smart purchase of St Paul Radiology’s business office better positions the teleradiology provider to more effectively provide final reads and also suggests a prescient understanding that the radiology provider of the future will need expert fiscal management and total command of its data.

The American College of Radiology: A Gold Star
The college should be rewarded for finally stepping out on the issue of radiation dose and proposing that radiation control be added to CMS’s Physician Quality Reporting Initiative (PQRI) program in 2008. Medical physicists have long advocated the as low as reasonably allowable (ALARA) principle within the profession. If radiation dose management is part of the PQRI, referring physicians also will get the message.

The ACRIN Trial 6667 Investigators: Something Nice Tied in Pink Ribbon
In this climate of imaging austerity, it would have been very tempting for payors to squelch the nascent practice of breast MRI. Instead, breast cancer patients can thank the ACRIN Trial 6667 investigators for showing payors what they needed to see: fast and hard data proving that breast MRI of the contralateral breast when a patient is diagnosed with breast cancer is good medicine.

Best wishes to one and all for a happy, prosperous, and, above all, healthy New Year.

Cheryl Proval is business editor for Axis Imaging News. For more information, contact .