The Affordable Care Act's Potential Impact on Radiology

Very soon the question of whether the Affordable Care Act (ACA) is constitutional will be decided. Radiology is an area that may be dramatically impacted by that decision.

There are valid points on both sides of the debate. Whether any of us reads a study has little to do with decision. Which and how patients get imaging may be affected, however. Radiology has become a powerful tool as a screening test in the emergency room. Patients there are more likely than outpatients to use radiology services.

Since I was a resident, the industry has moved from a time when radiology was used sparingly for diagnosis in after-hours and ER care to a time when it is used ubiquitously; and the uninsured access care through the ER even more often than the insured population. As a result the uninsured use imaging very heavily. Sometimes that is costly, as a lack of longitudinal care and the need for prudence in the ER means that radiology services are used more than may be needed.

There would likely be a decrease in use of basic radiology services in hospital-based settings with implementation of the ACA. That may not impact many radiologists. And higher end services would appear to be affected very little.

But there is a catch. Without coverage for those ER patients, utilization will increase overall. It has for some time, and that trend would continue, given a new generation of physicians who are increasingly reliant on radiology services for diagnosis. With that, the portion of health expenses used on imaging, especially more basic imaging and ER imaging, will increase. That can’t continue indefinitely.

So what will stop it? Likely, changes in provider coverage, or increased restrictions on use of radiology by insurers. And they will have a hard time restricting use of such services in the ER and for uninsured and sick walk-ins.

So what would be limited? The studies they can control and the most expensive studies: higher-end procedures and advanced imaging. So the catch may be that with the ACA, lower end, sometimes unnecessary, use of radiology services may be reduced. And without it, there may be a reduction in use of more appropriate and advanced radiologic services. That is not an endorsement of the ACA; it is an observation.

But perhaps there is a third path: more active involvement of radiology and radiologists in decisions about appropriate use, rather than having any mandate imposed on the industry, either by legislation or by insurers.