When Bibb Allen, M.D., surveys the imaging landscape, he sees a pockmarked fiscal terrain. Currently serving as vice chair of the American College of Radiology's Board of Chancellors, the 21-year industry veteran says a combination of factors is putting unprecedented economic pressure on imaging.
The Centers for Medicare and Medicaid Services 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.
Add to that declining volume-the Medical Imaging and Technology Alliance estimates that studies were down 3 percent in 2010 among Medicare recipients, and a utilization study by the Health Care Cost Institute found a 5.6 percent decrease in radiology services utilization for private insurers in 2010.
Those declines are in part due to the recession, in part to the rise of non-invasive surgical procedures which no longer require as much imaging, Allen says. Regardless of the cause, you have the elements of fiscal uncertainty. "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." Not only that, Allen says that in the rapidly emerging quality and outcomes-conscious era of accountable care, radiologists will have to assume a new role-one wrapped around assuring appropriate utilization, rather than just churning out reports at the behest of referring physicians.
The changes are reverberating throughout the imaging industry, experts say. Many radiologists say they feel like they're in the crosshairs of payers, which often see imaging as an expensive line item that's prone to over-utilization. In addition, the rise of accountable care organizations also puts radiologists in a tenuous financial position as they struggle to gain at a voice at the table when it comes to administering new ACO reimbursement models such as bundled payments.
Radiology is an I.T.-rich environment. Digital imaging has all but replaced film, and picture archiving and communications systems have become the norm and have streamlined image gathering and report writing. But the next big I.T. wave hitting radiology will incorporate more decision support tools, data analytics and perhaps even personal imaging records as the industry transitions away from fee-for-service to outcomes-based pay.
“Tight Squeeze,” Gary Baldwin’s feature story in the November issue of Health Data Management, explores the challenges in a new era for medical imaging.
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