Local, State, Federal

Exploring the Single-Payor Model and Radiology
Radiology Coalition Aims to Save Cancer Screening

Exploring the Single-Payor Model and Radiology

As of this writing in early September, the fight over health care reform in the United States continues. Many models have been suggested to cover the uninsured, including a public option, a co-operative insurance option, and a Medicare-style single-payor option.

While few pundits see the single-payor option surviving past a vote of the full Congress, House Speaker Nancy Pelosi has pledged to allow an up or down vote on a single-payor plan. If such a plan were to somehow survive both houses of Congress, what would such a program mean for radiologists?

Quentin D. Young, MD

Quentin D. Young, MD, national coordinator for Chicago-based Physicians for a National Health Program (PNHP), said that the effect on radiologists would depend largely on the details of the final bill and how radiologists?or any specialty?negotiated collectively for their fees.

He noted that under single-payor programs in other industrialized countries, physicians are paid in a variety of ways, so it would be difficult to predict a specialist’s single-payor fee structure here without the final bill.

Young said, “In Canada, for example, they have negotiations by medical organizations similar to the AMA [The American Medical Association] and the other specialty societies. They negotiate for the physicians, and these negotiations have been described as ?pit bull negotiations’ because they’re very heated and there’s a lot on the table.”

As to how specialty groups fare in terms of income, Young concedes that all specialty groups?including radiologists?earn less than their American counterparts, while primary care physicians make more.

However, Young also pointed out that radiologists would most likely increase their volume of patients, and thus may compensate for lower negotiated fees.

“A whole variety of patients needing radiologic services would come into play,” Young said. “Millions of women who don’t have the appropriate mammograms at the right time and a variety of uninsured people who are not in the keep of physicians would now be utilizing radiology services. That whole cohort of some 50 million formerly uninsured people would become available for radiologic services.”

In terms of the fee structure for radiology services, Young does not see it changing from the current Medicare system, where there would still be a separate technical fee and a professional fee. Individual providers would still have to purchase their own office space, PACS, modalities, and payroll.

As for imaging utilization, Young said that single-payor permits more outcomes research and quality control that will ultimately uncover the most feasible and appropriate treatment.

“Such an environment will carefully identify best practices for CT scan utilization, for example, and give the doctor a more sensible and reliable guide for what to do in a given situation. That’s the way single-payor will reduce costs?if they’re even reducible. We’ve left the door open that we may have to increase or decrease, depending on what’s found.”

Young also does not believe that a single-payor system will have the effect of reducing innovation, new technologies, or new techniques.

“I believe that’s exaggerated, in terms of the need to have this private research and private equipment. The actual fact is that the main source of new innovations in the health sciences in this country comes from government-sponsored medicine. The National Institutes of Health (NIH)?by a country mile?is the most important experimental support group in the world, and the bulk of the drug breakthroughs and other new technologies are actually sponsored and funded by the NIH.”

As of early September, radiologists seem unlikely to be affected by the passage of a single-payor program. However, PNHP describes itself as an organization of 16,000 physicians, and it remains to be seen whether the efforts of these physicians and other policy makers will make a difference in making a single-payor a politically viable option.

For more information about PNHP efforts, visit www.PNHP.org.

?Tor Valenza

Radiology Coalition Aims to Save Cancer Screening

Radiologists throughout metropolitan New York are trying to stop a crisis. It’s not because there has been an outbreak of a new disease or a lack of materials or patients have stopped coming to their offices. The threat is coming from the US government, which has proposed cutting reimbursement for a range of tests?which could put screening centers out of business and limit patient access.

In response, a group of New York-based radiologists have organized the Emergency Coalition to Save Cancer Imaging (ECSCI) to petition Congressional leaders not to make reimbursement cuts to high-end screening modalities such as CT, MRI, and PET.

According to coalition member and spokesperson Eric Schnipper, MD, a radiologist working in Long Island, the proposed cuts would include at least a 40% reduction in the technical reimbursement. On top of the cuts caused by the Deficit Reduction Act of 2005?which trimmed more than $1.64 billion in Medicare reimbursements in 2007 when it was implemented?more radiologists will be forced to close up shop, according to Schnipper.

And those who survive will not be able to afford to offer loss-leader screening exams such as mammograms, which typically result in a loss of about $45 per scan. In fact, according to ECSCI statistics, New York City alone has lost about 67 clinics since 1999. These groups accounted for 26% of all the facilities offering screening mammograms. This has also increased wait times by 171% over the last 10 years, which has seriously impacted access to life-saving imaging studies for women, minorities, and the elderly, according to the group.

To counteract this, ECSCI’s 14 radiology groups aim to raise awareness about the issue by circulating a petition in their offices and online.

The results have been overwhelming?in a 3-week span, more than 12,500 patients signed the petition during office visits. Schnipper makes it clear that patients aren’t required to sign the petition. It’s simply made available with accompanying literature in the waiting rooms. The first petitions have been sent to Representative Charles Rangel (D-NY), chair of the House Ways and Means Committee, and to Senator Chuck Schumer (R-NY), a member of the Senate’s Subcommittee on Health Care. Both men are the 14 groups’ and their 1 million patients’ representatives. Schnipper says that, thanks to that connection and the overwhelming response, the petitions and the ECSCI have “gotten some interest” and the legislators are “paying attention” to the group.

The ECSCI is wholly independent from any professional or legislative action group, though, Schnipper says, he has sought advice?and nothing more?from the American College of Radiology.

While the ECSCI is leveraging its legislative advantage as best it can, it’s not the only group out there who is speaking up. Schnipper says that there is at least one other group in Tulsa, Okla, that is organizing its own grassroots action.

Thanks to the Internet, the ECSCI’s grassroots petition drive could go national. “I’d be happy with that,” said Schnipper.

Anyone?whether they’re radiologists, technologists, or patients?can sign the petition online by going to www.savecancerimaging.org. Because it’s a national issue, there is no need for the signer to live in New York.

But the petition is only the beginning. The ECSCI has engaged a PR communications firm to arrange a press conference to raise awareness about the impact of this legislation and deliver a simple message. “It’s all about access,” said Schnipper.

?C.A. Wolski