Saturday, September 24, 2011

Medicare Cuts for Imaging?

We all sit and wait for a glimpse at the ugly head of healthcare reform.  Nobody knows exactly what it looks like or what it will mean for their own care, the care of their families, or for us Radiographers, our jobs.  This article from the Wall Street Journal was posted in July:

http://online.wsj.com/article/SB124646885862181139.html

It outlines plans for Radiologists to receive up to 20% cuts for reimbursement for MRI and CT scans.  It also mentions Cardiologists receiving 25% reduction in cardiac catheterization procedures and 42% cuts for echocardiograms.  These are among just a few of the cuts that are reported to be re-channeled toward primary care in hopes of attracting more medical students by increasing GPs' wages.

The American College of Radiology has been fighting President Obama on some of these changes with the backing of U.S. senators on both sides of the isle, including Kerry (Democrat from MA), Kohl (Democrat from WI),and Alexander (Republican from TN).  The imaging community has already seen cuts of $5 billion over the last 5 years, and as of September, we are now facing increased expectations of not 20%, but up to 60% cuts for CT and MRI reimbursement from Medicare.  The last time I checked, most hospitals are already in the red.

According to Obama's Deficit Reduction Plan (page 38), patients will even need "prior authorization" for the more expensive imaging studies starting in 2013 in order to patrol the actual necessity of more expensive studies.  There is a common opinion going around that too many CT and MRI exams are being ordered when they are not really necessary in order to make the pockets of Physicians a little bulkier.  The pre-authorization is supposed to prevent this sort of thing, but what concerns me is that the plan does not identify WHO would be doing this pre-screening.

I can't think of too many people who would not be biased in the pre-screening process.  A Physician panel may side on lining the pockets of their own.  Insurance companies are going to find a way to make a buck off of it themselves.  The most likely responsible party will be Big Gov - and now we open the can of worms that everyone's been talking about for some time... government regulated health care.  Is this the beginning of a long-term agenda to force everyone to switch over?  Who knows... but I would like to encourage everyone to write their Congressmen and Senators and support the ACR.

What will this mean for Radiographers?  It could mean more plain x-ray exams being performed - we may continue to be the work horse of the imaging department.  It could also mean less Physicians specializing in Radiology.  We live in interesting times in the health care field.  I have serious doubts that plain x-ray examinations are going anywhere soon.  I do think, however, that we will most likely see a slower growth in imaging technology if this goes through.





2 comments:

  1. In my view, the ER Physicians are main culprit of unnecessary CT scans. I couldn't even fathom the number of patients who received CT Head scans for headaches regardless of medical history and/or clinical assessment (if the ER physician took the time to perform one). Moreover, MVA patients routinely receive 3-6 CT scans to rule-out whatever since they're easier for the ER doc to order and defer the diagnosis to the on-call Rad verses performing a clinical assessment - I can't recall the last time I observed an ER physician temporarily remove a patient from the backboard and "log rolled" him/her to diagnose possible spinal/vertebral column. Hey, chalk it up to defensive medicine...

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  2. I agree... it seems like the med schools are churning out grads to be timid compared to when I started working in this field. I can't remember the last time that I did a cross-table lateral c-spine for clearance from a collar. I will be interested in seeing what happens with the rise of tomosynthesis.

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