What Health Reform Means for Radiologists

The health care system as you’ve known it will look drastically different within the next few years, and the radiology industry is set to change with it. If you want to stay afloat and have a competitive practice, you must know which parts of the health reform legislation will affect you and how to handle them.

That’s the message from Robert Still, MD, practice manager for Lancaster Radiology Associates Ltd. in Auburn, Pa. Speaking at the AHRA: The Association for Medical Imaging Management annual meeting in Dallas next week, Still says accountability will be the most important thing to remember as health reform legislation comes online.

“The ways we measure quality in health care and radiology will change. The focus will be higher quality at lower cost,” he said. “As accountable care organizations are introduced, all payments will be bundled and reimbursements will be value based.”

This bundling means you will no longer be reimbursed separately for your services. Instead, your payments will be part of a larger one that includes facility, technical, and physician charges. It could also mean you start assuming a more consultative role in patient care, offering input and making recommendations about which imaging studies are most appropriate, Still said.
This change has industry leaders concerned. They fear policymakers are following MedPAC’s lead in considering bundles or cuts to all the payment codes you use.

“There will be a huge impact in reimbursement if every code is up for grabs,” said Maurine Dennis, senior director of economics and health policy at the American College of Radiology. “Diagnostic radiology is behind the 8-ball and is feeling the biggest impact from reform.”

To off-set the drop in payment, many radiologists could be forced to move back into a hospital-based setting. But this shift could create an access-to-care problem, Dennis said, as imaging centers in far-flung, rural areas shut down and consolidate services in a local or regional hospital.

In addition, there is a drive to require preauthorization for all advanced imaging studies. Controlling costs is the impetus behind the measure, but the consequences could adversely impact patient care.

“This step has broad implications for radiology,” Still said. “This would be a hard-stop measure that would prevent radiologists from doing a study without authorization and wouldn’t allow them to go back to the referring physician to see why the study wasn’t pre-authorized.”

Practicing radiologists share the same reservations because packaged or curtailed services and reduced reimbursements are tough pills to swallow, said Sidney Roberts, MD, president of the Texas Radiological Society and a radiation oncologist at the Arthur Temple Sr. Regional Cancer Center. The complexity and size of health care reform has many providers feeling paralyzed.

“There’s almost a sense of helplessness for the individual radiologist,” Roberts said. “They see cut, cut, cut, year after year. Individual practitioners will be reading more films per day, per year for less reimbursement. It’s enough to potentially drive solo radiologists into group practice or a hospital arrangement.”

However, if you are hospital based and use hospital-provided technology, you might be negatively impacted as meaningful use is enforced, said Barbara Rubel, fellowship committee chair for the Radiology Business Management Association (RBMA). Under CMS’s regulation, providers and hospitals must prove by 2015 they are effectively using electronic health records.

But depending on where you practice and how much time you spend there, you might not receive the $44,000 Medicare meaningful use incentive payment.

“When CMS implements the law, if you’re working more than 90 percent of the time in a hospital inpatient setting or emergency room, you’re excluded from payment incentives and penalties,” Rubel said. “But we haven’t found any radiologist in a hospital setting who spends 10 percent or less of his or her time in an outpatient clinic.”

Instead, if you do work in an outpatient setting, you likely spent 30 percent to 40 percent of your time there, Rubel said, so you won’t be able to comply with meaningful use. That means you could stand to see cuts in reimbursement in the future.

RBMA is currently in the midst of discussing with CMS strategies that would make radiologists who fall into this category eligible for incentive payments even if they can’t meet CMS’s standards. The hope, Still said, is that both CMS and congressional leaders will realize reform efforts have hit radiology dramatically and that they will move on to other specialties.

In the meantime, you can minimize the pain you’ll feel from any loss in reimbursement, Still said. But, it will likely require some tough choices.

“Administrators need to sit down together and dig in deeper to drive cost inefficiencies out of their systems,” he said. “The radiologists and vendors should also be involved in the conversation to make the best decisions about efficient software and hardware that will be useful.”

Also, don’t forget to voice your concerns to your congressional representatives, Dennis said. The ACR has drafted a template letter, informing elected officials about what radiologists do and why the industry is important to health care. The goal, she said, is to potentially prevent some of the negative impact health care reform will have on radiology.

But remember, Still said, health care reform is about how to deliver the best quality services efficiently. Radiology has an important role to play in reaching that goal.

“Radiology in general is at a very interesting point. It’s always used cutting edge technology to deliver the right study at the right time in a cost effective way for the patient,” Still said. “Now, it’s in a unique position to figure out the new face of radiology while spending less and still delivering and tracking quality diagnoses and patient care.”