Bibb Allen, M.D, vice chair of the American College of Radiology's Board of Chancellors and 21-year industry veteran says many factorsincluding fear of over-exposure and payment reductions for imaging servicesare putting unprecedented economic pressure on radiology. Just how much?
CMS has been cutting reimbursement for radiology services since the Deficit Reduction Act in 2006, he says, with reimbursements for some studies declining by 50 percent since the act and six subsequent CMS cuts. Whats the result?
Declines stem from both the recession and the rise of non-invasive surgical procedures requiring minimal imaging, Allen says. "There is full employment in radiology," he acknowledges. "The American College of Radiology data show the same number of people retiring as graduating. But the idea of getting five job offers in your hometown after residency is not happening anymore. Radiologists cannot be picky about where they work."
Payment reductions in the fee-for-service world are walloping imaging practices. "Imaging is in the line of fire because it is easy for CMS to tackle," says Chad Wiggins, CEO of Radiology Associates of Northern Kentucky. The economics of imaging rankle Wiggins. "One of the biggest points of contention I have with CMS is the talk about over-utilizationit is completely inaccurate. The radiologist is not the referring source. We are the recipient."
CMS price cuts have hit deeply. Two years ago, CMS altered its reimbursement policy on CTs of the pelvis and abdomen, combining the formerly separate services into a single, reduced fee. "It comes back as one study, but the doctors would interpret them as separate studies," Wiggins explains. The new policy dinged the practice at about $388,000 in reduced annual revenue, he says. "It was not an elegant approach to cost reduction. It was a hatchet approach. But it saved a significant amount of money. Our fear is that we will continue to see Medicare combine procedures."
With an eye to the future, the ACR has launched ACRSelect.org, which provides embedded decision support rules for ordering radiology exams. Enhanced decision support in electronic ordering systems-the point of origin for many imaging exams-is a critical first step in improving imaging operations and reducing waste, Allen says.
Allen says future radiologists must be imaging consultants. "Radiologists would answer the phone when the referring physician has a question on the appropriateness of an order, he says. We would be the arbiters. It is not something you make an RVU for, but it would be a value-added service that in the long run will be of more benefit. Radiologists have to understand that in the future, this is what we will have to do."
To read more about the economic squeeze on imaging, see our November feature story.
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