Editor's note: This blog post is written by Alex Tolbert, founder of Bernard Health.
Our healthcare system is broken partly because consumers don't
know what anything costs. As patients become more proactive in making informed
healthcare decisions, we all agree this should be fixed. But why is it so hard?
Achieving price transparency in healthcare is difficult because healthcare
business models rely heavily on a lack of transparency.
Insurers, hospitals and providers want a better healthcare
system as much as anyone, but can't afford to inflict damage on their businesses
by making prices transparent overnight.
To better understand how transparency affects healthcare, let's
take a look at the business models for insurers and hospitals.
Insurer Business Model
If prices were completely transparent, then insurance companies
who had negotiated the lowest prices would begin to lose their primary
advantage. This is because that pricing information would give medical
providers and other insurance companies more power when negotiating and
competing with them.
An insurer's business model can be boiled down to this:
- Negotiate discounted prices with providers.
- Insure people, collect premiums.
- Pay claims to providers at discounted prices.
- Keep the difference.
Since that is the business, here is how you win financially:
- Negotiate the lowest prices with
- Offer the lowest premiums so you can attract
the most insured people.
- Enjoy the virtuous cycle that ensues.
What virtuous cycle?
The more people you insure, the lower the prices you can get
from providers. If you can get the lowest prices, you can offer the lowest
premiums. Offering the lowest premiums will win you the most insured people,
and so you can continue to negotiate the lowest prices from providers. And so
Hospital System Business
If prices were completely transparent, then it would be
difficult for the hospitals to justify the high prices they charge for things
available elsewhere for a fraction of the price. In other words, if everyone
knew that "Procedure ABC" costs $3,800 at the hospital and $600 for the same
quality at a standalone facility next door, the hospital would lose a lot of
The typical hospital system business model can be boiled down to
- Negotiate prices with insurers to be
- Get paid at those prices on patient claims
submitted to insurers.
- Pay your doctors, "midlevel" providers, nurses
and facility/equipment costs.
- Keep the difference.
Since this is the business, here is how you win financially:
- Negotiate the highest prices with insurers.
- See as many patients as possible.
- Submit as many claims as possible for each
It's a lot easier to do more tests/procedures per patient than
to attract more patients. As such, your contracted prices for tests and
procedures are really important.
Fortunately, as a hospital system, your size gives you leverage
when negotiating with insurers. The insurers need you in their network more
than they need a given imaging center. As a result, you're able to negotiate prices that are a lot higher and still be in-network.
Fueling the Movement Toward
Creating a better healthcare system starts with price
transparency. The growth of health savings accounts and transparency start-ups,
like Healthcare Blue Book and Change:Healthcare have fueled the movement toward
In addition, insurers and hospitals are working hard to provide
transparency. To offset the damage transparency will inflict on their business
models, they're working to develop other competitive advantages.
As consumers continue to share the burden of ever-increasing
healthcare costs, it's only fair that they be armed with the information needed
to make informed decisions about their healthcare. This transparency will lead
to a better-functioning and lower-cost system with happier providers and
Editor's note: This article was posted with permission from its author, Christine Gondos, Igloo Software. She can be reached at email@example.com.
The fastpaced healthcare industry is continuously evolving --
whether it be newly released studies, new best practices or new techniques, the
healthcare community thrives off of innovation.
annual conferences provide the opportunity for healthcare professionals to
connect, the majority of professionals rely on email to exchange new findings.
Healthcare professionals have recently placed an importance on social media
networks (such as Twitter) as an additional outlet to exchange ideas. While
social media provides an opportunity for medical professionals to connect and
discuss best practices, this ultimately becomes problematic due to the
confidential nature of the discussions.
how can healthcare professionals network, engage in conversations about practice and
share knowledge while maintaining confidentiality and ethical standards?
Software's Senior Vice President of Marketing & Operations, Andrew
recently presented at the CIO Healthcare Summit where he discussed "How
Healthcare Organizations are Moving from Social Media Marketing to
Business Strategy." Instead of connecting on public social networks,
more healthcare organizations are creating a social business strategy so
can collaborate on their own private network.
Secure enterprise social platform
organizations like Igloo
unite healthcare professionals, practitioners and
patients so they can collaborate on ideas and keep information in one
area. After a patient leaves the office, you no longer need to feel that
sense of ambiguity questioning if you remembered everything he or she
longer does a conversation need to live in the room you had it; nor your
inbox, nor your notebook.
Enterprise social software erases ambiguity and allows information to be
accessible yet secure. Here are four use cases of how enterprise
social software enables healthcare professionals to stay connected outside the office.
- Kimberly-Clark Clinical Solutions
is a health division of a large consumer goods company that has a very large
health product portfolio including medical devices & infection prevention.
To facilitate research, they launched a social extranet solution to act as a
product evaluation center for open innovation & customer engagement.
- Ontario Health Quality Council,
an independent provincial body for patient care, coordinates a myriad of
stakeholders in a member portal to report on the health system's effectiveness
and opportunities for process improvement.
Are your patients curious about learning more
information about what you said in a recent appointment? While you may question the
validity of checking Wikipedia or the intimidating results Google reports back,
patients often feel alone when they leave their provider's appointment.
Healthcare organizations realize this and have bridged the gap by offering
patients a portal where they can connect.
National Medical Center provides patients with a secure, private virtual
place where they can ask questions, find answers and share experiences around a
specific health condition. Their Emergency Medical Services for Children
Program (EMSC) National Resource Center also provides a secure portal for
grantees to interact and share information with each other in support of EMSC's
national child advocacy programs.
Want to bring together key stakeholders within a healthcare
association to work together and improve healthcare delivery? A
conference may be a great way to get everyone together, but how will you
Enterprise social software platforms provide practitioners a
specific work area where they can collaborate on documents and share best
Drug Information Association uses a social
extranet to connect their 18,000 members in the biopharmaceutical industry for
online learning, collaboration and managing their communities of practice.
Since adopting this new form of technology, their collaboration tools are now
streamlined and this area facilitates knowledge exchange and relationship
building in a private member portal for their 32 special interest groups.
American Academy of Family Physicians (AAFP),
representing more than 100,000 family
physicians and medical students nationwide, improved their collaboration since
launching an online community for peer networking, information sharing and
practice transformation. Members have access to online seminars, practice
tools and the "Ask An Expert" area. Known as Delta Exchange, the award-winning online
network connects physicians, clinical staff, office staff and primary
care-focused residency programs committed to the Patient Centered Medical Home.
wholly-owned subsidiary of the American Academy of Family Physicians (AAFP)
also capitalized on the benefits of social collaboration. In an effort to
improve patient care and assist primary care physicians with medical practice
redesign, over 500 practices and more than 5,000 medical professionals across
the country connect and collaborate using Igloo Software.
External facing communities (extranets) have gained
tremendous momentum for healthcare organizations. Effective collaboration,
improved knowledge sharing, and accessibility anywhere - it is no wonder that
more and more healthcare organizations like The College of Family Physicians of Canada,
are adopting social intranets to collaborate inside their organization.
Bye bye filing cabinets and shared folders.
The organizations mentioned
above stay organized with hierarchical storage of documents with unlimited folders, inline preview
and full version control. Organizations and associations in the
healthcare industry now have the power to stay connected to other healthcare
professionals, practitioners and patients in a secure environment where
confidential information is safe.
For more information, visit http://www.igloosoftware.com/blogs/inside-igloo/continuingtheconversationoutsidethedoctorsoffice4waystostayconnected
Editor's note: This blog is written by Anthony J. Hall, RN, BSN,
behavioral health charge nurse at Atlanta Medical Center.
The Affordable Care Act (ACA) means major changes in the way
Americans view health issues and treatment options. While there is increased
optimism building around the plan's effect on patient care, healthcare
providers will bear the burden of the plan's negative impacts, such as a
shortage of primary care providers. Though the full impact on the medical
profession has been hard to gauge, providers can be primed for some positive
adjustments as a result of ACA.
It's easy to see the immediate benefits of the ACA for healthcare
recipients - many more families will be able to schedule regular visits to a
general practitioner or family clinic, meaning more check-ups and preventative
For healthcare professionals, this increased patient load means
more providers will be needed; some will gain traction in positions of greater
authority as those with less experience are hired. The shortage of primary care
physicians will mean increased access to nurse practitioners (NPs) and
physician assistants (PAs), allowing localized healthcare to more patients, making
it unnecessary to travel to distant hospitals.
The increased presence of non-physician providers such as
laboratory professionals, respiratory technicians, NPs and PAs in
decision-making positions will bring a heightened awareness and a sense of
respect that has been long overdue. In my work with patients and the general
public, I've encountered many people who are uncertain of the role these
professionals play; by virtue of increased demand, more patients will become
aware of our importance in healthcare.
While many hospital systems are consolidating, combining forces
and units to avoid producing duplicate services, job cuts in the hospital sector
will provide an upswing in business for small practices, family clinics and
general practitioners. This change is likely to mean an increase in employment
for providers in all areas of specialization.
If you are interested in submitting to the Politics of Healthcare
blog, please contact Kelly Wolfgang at firstname.lastname@example.org.
Editor's note: This blog is written by Miguel
A. Bustillos, department chair and professor at California University of
Management & Sciences in Virginia.
us have heard about the Medicaid expansion and how states like Florida, Texas
and Virginia are against it. Some do not understand why the Medicaid expansion
has become such a big issue or what exactly the Medicaid expansion is.
Medicaid expansion, expected to be fully implemented by 2014, is a plan under the
Patient Protection and Affordable Care Act (PPACA) to expand medical coverage
for a number of people who do not qualify under the current plan. The Medicaid expansion
mandates that a state must meet PPACA standards to receive full federal funding,
which is needed to increase the current plan. The largest problem involving the
mandate is how states will cover the "new eligibles," those patients who are
receiving Medicaid assistance for the first time. It is estimated that 15.9
million new enrollees will participate in the plan by 2019.
federal government currently pays, on average, about 57% of the total cost of
Medicaid enrollees in each state. Of those that qualify for Medicaid, only 62%
have signed up for Medicaid benefits, leaving the remaining 38% without benefits.
Generally, those that are not taking the benefit either don't know that they
qualify or refused the benefit.
were to accept the Medicaid expansion, they would continue to pay for the
benefits of the 62% that are currently covered; in addition, they will have to
cover the 38% that qualified under the previous requirement, but did not take
the benefit. According to the new mandate, states must also provide for the new
the Medicaid expansion mandate, the federal government will continue to pay the
cost for about 57% of the 62% that are currently taking the benefit. With the
new law, the 38% that did not receive benefits will now either take the benefit
or pay a tax penalty. Some states believe that those who are qualified will
take the benefit rather than pay the penalty. Despite the "new enrollee" status
of those patients, the government will not support funding for any persons who
previously qualified but did not receive benefits.
regards to the true new eligible, the states believe that the cost of providing
Medicaid is just too large for any state to handle. To lessen the burden, the federal government has
penned an agreement to cover 93% of the cost of the true "new enrollees" till
the year 2020.
will decline to take on the Medicaid expansion because it's a voluntary program.
The new law can be very taxing to any state's budget and in most cases, there
are not enough incentives for states to adapt the program.
federal government is, however, not worried. When Medicaid was first signed
into law in 1965, only six states agreed to participate. But by 1982, every
state had joined. As 2014 comes along, and the law comes into full effect, it
will be interesting to see what develops and what does not. With the cost of
providing healthcare to so many people being so high, and the fact that
Medicare benefits will be cut to fund the Medicaid expansion, I foresee much
resistance on its implementation.
reported on Newswise, the
following is a statement by Jo Ivey Boufford, MD, president of The New York
Academy of Medicine, one of the nation's oldest and most prestigious medical
academies, on the seriousness of gun violence as a major public health issue.
The statement is in response to deadly incidents of gun violence in Newtown,
CT, Webster, NY, and the shooting of 15 individuals, three of whom died, during
separate acts of gun violence in Chicago, IL on New Year's Day.
"As a nation, we can only improve the health of the
public when we get our priorities straight. Recent acts of gun violence in
Chicago, Webster, NY, and Newtown, CT cannot be ignored. Neither can the 31,000
Americans who die each year at the hands of a gun. This number exceeds the
number of babies who die each year during their first year of life (25,000) or
people who die from AIDS (9,500) or illicit drugs (17,000).
institute protective measures enforcing speed limits and requiring the use of
safety belts; we implement public health measures such as child vaccinations
and regulations around the safety of food, drugs, and products. Yet guns escape
this type of regulation despite their significant contribution to the mortality
rate each year. We must view gun violence as a serious threat to the public's
health if we want to reduce the number of deaths associated with guns.
can start by banning the sale of assault rifles, high-capacity magazines, and
other facilitators of mass murder. And we must allow government agencies like
the Centers for Disease Control and Prevention to fully exercise their duties
in both surveillance of the incidence and impact of gun violence, and in
educating the public on steps for preventing death and injury through the use
evidence is clear, and we must now take action to protect our neighbors and
ourselves from this devastating public health crisis."
the American Nurses Association and the American College of Emergency
Physicians, two prominent and national healthcare organizations, issued calls
for a ban on the sale of assault weapons.
publication ADVANCE for Nurse Practitioners & Physician Assistants
asked its readers, "Do you think it is the responsibility of healthcare provider
organizations to urge this type of action?"
some readers had to say:
- "We can
all do our part. As nurses, as humans." - Teanne
stand in a trauma unit for one night and come back and give me your
answer." - Melissa
Absolutely! It's everyone's responsibility to speak up for what they
believe!" - Kelli
not. I have stood in the trauma unit for 15 years and taking away my legal
guns, which I carry concealed because I am licensed to do so, and taking
away my rifles, which I enjoy shooting responsibly, will do nothing to
stop the common street thug with an illegal weapon, other than allow me no
protection for myself and my property when I'm leaving the trauma unit at
midnight, sitting at a red light, and getting jacked by said thug." -
of our ER staff is armed; we see what's out there. As the Boy Scouts say,
be prepared. The bad guys will always find guns; we need to be able to
defend ourselves." - Diana
Prior trauma nurse here at Miami Dade County. Some individuals have no
business having weapons. Period." - Teresa
is definitely not the responsibility of healthcare provider organizations.
This is a civil liberty. I'm sure many members of the groups do not
support a ban. These groups should focus on healthcare issues." -
mental illness awareness and research would be a wiser choice! Let's be
honest, what health professional has not taken some form of weapon to work
with them?" - Susan
you agree with Boufford's statement and the calls for action by the American
Nurses Association and the American College of Emergency Physicians? Weigh in
on the comments below.
Editor's note: We welcome your comments and
topic suggestions; contact blog author Kelly Wolfgang at
Winners of an HHS public data and cancer challenge have created health IT applications that use public data and existing technology to help patients and health care professionals prevent, detect, diagnose, and treat cancer. The two winners presented their submissions during a special symposium at the Hawaii International Conference on Systems Sciences and were each awarded $20,000 by the Office for the National Coordinator for Health Information Technology. The two winning applications include:
• Ask Dory! -- submitted by Chintan Patel, PhD; Sharib Khan, MD, MA, MPH; and Aamir Hussain of Applied Informatics LLC -- helps patients find information about clinical trials for cancer and other diseases, integrating data from www.ClinicalTrials.gov and making use of an entropy-based, decision-tree algorithm. A functional demonstration of the application is available at http://Dory.trialx.com.
• My Cancer Genome -- submitted by Mia Levy, PhD, MD, of the Vanderbilt University Medical Center -- provides therapeutic options based on the individual patient’s tumor gene mutations, making use of the NCI’s physician data query clinical trial registry data set and information on genes being evaluated in therapeutic clinical trials. The app is in operation at www.MyCancerGenome.org.
Information on the four semifinalist teams can be found at http://go.USA.gov/5DA.
Lawmakers averted a year-end deadline for Medicare physician payment cuts after the House reversed course Dec. 23 by supporting a two-month patch for the physician payment formula. President Obama then signed the measure blocking the 27.4 percent pay cut, setting up another showdown in the first two months of 2012 when Congress returns to Washington.
“ASTRO is pleased that no cuts to radiation oncology were used to pay for the short fix, and the society will continue urging Congress to enact a permanent solution to the physician payment formula in 2012,” the organization stated.
Due to intensive educational efforts by the American College of Radiology, the Centers for Medicare and Medicaid Services (CMS) has informed the ACR that "operational limitations" will prevent them from applying the imaging professional component Multiple Procedure Payment Reduction (MPPR) to group practices beginning Jan. 1, 2012. Therefore, CMS will not apply the professional component MPPR for imaging services performed by separate physicians in the same group practice for 2012. This decision will affect both office and hospital practices.
Application of a 25 percent MPPR to the professional component of diagnostic imaging services performed by the same physician, to the same patient, during the same session remains the same. However, the ACR will continue its legislative efforts to block the entire professional component MPPR through enactment of H.R. 3269 in the second session of the 112th Congress. There are now 150 co-sponsors for this bill.
"I am proud of the tremendous effort exerted by more than 7,000 ACR members to contact CMS and explain the flaws in its original ruling. I'm also very gratified and encouraged by the grassroots efforts of our members in gaining support from 150 members of Congress for H.R 3269" said John A. Patti, MD, FACR, chairman of the ACR Board of Chancellors. "While this bill did not appear in the final 2011 health care legislation, it is still alive and gaining more support for the next session."
"In addition to our members, I would like to thank the stellar ACR economics team of physicians and staff who spent countless hours developing strategy, collating supporting data, and meeting with CMS officials to achieve this unusual and extraordinary policy reversal," said Bibb Allen Jr., MD, FACR, chairman of the ACR Commission on Economics.
The Medical Imaging & Technology Alliance (MITA) applauded the Medicare Payment Advisory Commission (MedPAC) for confirming the recent downward trend in Medicare spending and utilization on medical imaging procedures. During its recent public meeting, MedPAC said imaging services declined by 2.5 percent in 2010, which is consistent with a MITA analysis of Medicare claims data commissioned this year.
"MITA is pleased that MedPAC has publicly validated that medical imaging spending and utilization are on the decline," said David Fisher, executive director of MITA. "We thank MedPAC for their careful review of the new data and their willingness to work with industry to develop a shared understanding of payment trends. MITA encourages policymakers to consider these latest trends and not target medical imaging services for additional cuts."
Recently, MITA released an analysis that found spending on imaging services for each Medicare beneficiary has dropped 13.2 percent since 2006, when significant imaging-specific reimbursement cuts from the Deficit Reduction Act began to be implemented, and imaging utilization per beneficiary declined by 3 percent in 2010. Contrary to the decline in imaging, spending for non-imaging Medicare services has grown by 20 percent since 2006 and non-imaging utilization increased 2 percent in 2010. The analysis also found that imaging is now a smaller portion of Medicare spending than it was at the turn of the century.
Congress and the administration have cut imaging reimbursements seven times in six years, with payments for some services being reduced by over 60 percent, including bone density screenings, arm and leg artery X-rays, and MRIs of the brain. These cuts hurt patient access and undercut the benefits of early detection, making it harder for doctors to access these life-saving technologies, MITA states.
MedPAC's conclusions on the MITA analysis are just the latest independent confirmation that Medicare imaging use and spending are down. In December, researchers at Thomas Jefferson Medical University found that from 2007 through 2009, there was significant curtailment of growth in CT and MRI, and the rate of nuclear medicine utilization actually decreased.
The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has released a report showing that doctors' adoption of health information technology (IT) doubled in two years. HHS also announced new actions to speed the use of health IT in doctors' offices and hospitals nationwide, which will improve health care and create jobs nationwide.
While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes, and reduce costs, HHS stated. The new administrative actions announced, made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
"When doctors and hospitals use health IT, patients get better care and we save money," said Sebelius. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs."
In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs. More than 50,000 health IT-related jobs have been created since the enactment of the HITECH Act. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.
HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.
These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs, HHS stated. For example, in communities across the country, the agency will target outreach, education, and training to Medicare-eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.
These efforts will complement existing outreach efforts to doctors and hospitals including the Obama administration's work to create a nationwide network of 62 Regional Extension Centers, HHS stated. The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
The Medical Imaging & Technology Alliance (MITA) was recognized for its participation in the United States Commerce Department's International Trade Administration (ITA) Market Development Cooperator Program (MDCP) at RSNA's Scientific Assembly and Annual Meeting. Working closely with the ITA and other stakeholders, MITA will utilize MDCP funding to improve government approval processes, decrease the time required to bring devices to market, and lower costs associated with international sales in nations such as China and India.
The three-year award from the United States Department of Commerce, named the Global Diagnostic and Therapeutic Imaging Access Improvement Initiative, will promote the harmonization of international standards, reduce unnecessary regulation, and expand market access to enhance the global competitiveness of MITA member companies, including small- and medium-sized enterprises. As market access improves, patients will benefit from enhanced diagnostics and care provided by life-saving medical imaging and radiotherapy devices. MITA was one of only five non-profit industry organizations to receive the MDCP award.
"Our partnership with ITA will help eliminate impediments to trade, allowing industry to more efficiently export innovative medical imaging and radiotherapy products to international markets such as China and India," said David Fisher, executive director of MITA. "MITA will leverage our deep expertise in industry standards-setting, our international program, and our experience within medical imaging and radiotherapy device regulatory arenas to drive international market access and growth."
"The MDCP award will help medical imaging and radiotherapy manufacturers create jobs in the United States by increasing access to international markets and thereby increasing exports of innovative life-saving medical imaging products," said U.S. Deputy Assistant Secretary of Manufacturing Peter Perez. "In total, the partnerships we are creating with the five new MDCP awards will increase the number of businesses in our country that receive assistance in exporting their goods and services to international markets and thereby create or sustain thousands of jobs in this country."
ITA will provide funds and expertise as part of a three-part program, including support from MITA and industry stakeholders. Through the program, MITA will better identify market problems, work more closely with Chinese and Indian regulators to enhance device safety and quality testing abilities, and assist them in integrating internationally accepted standards into their regulatory regimes. MITA's work within MDCP will also help educate international decision makers regarding the practical implications of policy decisions and encourage them to craft a regulatory environment that brings innovative and life-saving technology to patients while reducing errors and the long-term cost of care.
See more of our RSNA coverage here.
A new analysis of Medicare data, released by the Medical Imaging & Technology Alliance (MITA), finds that Medicare spending on medical imaging continues to decline and that Medicare patients are receiving fewer imaging procedures.
"This analysis confirms the downward trend in both imaging spending and utilization in Medicare that has occurred in recent years. The assumption that life-saving diagnostic imaging and radiation therapy are increasing health care costs is simply not true," said David Fisher, executive director of MITA. "Even in light of these significant downward trends in spending and utilization, policymakers continue to target medical imaging for more cuts, threating seniors' access to life-saving services."
The analysis shows that spending on imaging services for each Medicare beneficiary has dropped 13.2 percent since 2006, when significant imaging-specific reimbursement cuts from the Deficit Reduction Act began to be implemented, and imaging utilization per beneficiary declined by 3 percent in 2010. Meanwhile, spending for non-imaging Medicare services has grown by 20 percent since 2006 and utilization increased 2 percent in 2010.
The analysis also found that imaging is now a smaller portion of Medicare spending than it was at the turn of the century.
"It is unsettling to see these accelerating declines in Medicare beneficiaries' use of medical imaging services during a time of tremendous advances in imaging and radiation therapy technologies, which have become increasingly integral to medical best practices and early disease detection," said Fisher. "This disconnect raises serious concerns about whether or not patients are receiving the care they need."
Congress and the administration have cut imaging reimbursements seven times in six years, with payments for some services being reduced by over 60 percent, including bone density screenings, arm and leg artery X-rays, and MRIs of the brain, MITA stated. These cuts hurt patient access and undercut the benefits of early detection.
"There are enough barriers keeping patients from effective treatments," said Laurie Fenton, president of the Lung Cancer Alliance. "Congress shouldn't make it any harder for us." Further cuts to medical imaging will also make it harder for doctors to access lifesaving technologies.
"Current evidence, including this analysis, debunks the myth that imaging is significantly overused and somehow responsible for escalating healthcare costs. Unlike other areas of medicine, imaging utilization and spending are on the decline," said John A. Patti, MD, FACR, chair of the American College of Radiology Board of Chancellors. "According to these data, the goal of bending the cost curve has indeed been achieved for medical imaging. Any further reductions would represent socially irresponsible policy."
It is vital that policymakers use current data and research about imaging spending and utilization when making budget decisions that will affect patient access and quality of care, MITA stated.
The ACR released the following statement:
While the Centers for Medicare and Medicaid Services, in response to American College of Radiology data, and a furious response from the imaging community, revised the multiple procedure payment reduction for interpretation of imaging from 50 percent to 25 percent, the 25 percent cut is still unfounded and potentially dangerous. The unanticipated Final Rule expansion of this reduction to include multiple providers within the same group practice violates the spirit of the rulemaking process and indicates that CMS fundamentally misunderstands the practice of medicine.
"This extension of the multiple procedure payment reduction to include physicians in the same group practice was not specifically included in the 2012 Medicare Fee Schedule Proposed Rule," said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors. "No efficiencies in care support a funding cut when different physicians in a group practice interpret separate imaging scans for the same patient. There is no scientific support for this action. The Centers for Medicare and Medicaid Services should rescind it immediately."
There is no publicly available evidence to support a 25 percent reduction to physician interpretation payments in general. A recently published study proves that any efficiencies in the multiple procedure setting are highly variable and, at most, total one-fifth of what CMS contends.
"This multiple procedure reduction will affect the most vulnerable of Medicare beneficiaries: people suffering from multiple trauma, stroke patients, and those with widespread cancer--all of whom often require multiple imaging scans to survive serious illness and injury, the interpretation of which can often require the expertise of several different radiologists" said Dr. Patti. "Congress must act to protect seniors by passing the Diagnostic Imaging Services Protection Act (H.R. 3269).This act would block this multiple procedure payment reduction until and unless Medicare produces a study that would support such a cut in care."
Medicare funding for imaging scans has been slashed $5 billion since 2007. The Obama Administration recommended to the congressional supercommittee $1.3 billion more in imaging cuts. This may force many suburban and rural imaging providers to close, causing many seniors to travel farther and wait longer to receive care.
"A 2009 study conducted by the National Bureau of Economic Research showed that increased use of imaging is directly tied to increased life expectancy," said Bibb Allen Jr., MD, chair of the ACR Commission on Economics. "Those with less imaging access don't live as long. Continued cuts may cause more cancers and serious illnesses to go undetected until advanced stage, costing Medicare more money to treat and forcing patients to undergo more extensive treatment. These cuts may very well result in deaths that could be avoided through early diagnosis by imaging scans."
A recent national poll of 1,000 registered voters showed that nearly 90 percent of Americans believe more imaging cuts will affect early detection of medical conditions and diseases. A full 70 percent of Americans oppose further Medicare cuts to medical imaging.
Previously: ACR--Diagnostic Imaging Services Protection Act Helps Preserve Access to Care
The ACR released the following statement:
The American College of Radiology supports the Diagnostic Imaging Services Protection Act (H.R. 3269), which would prohibit any multiple procedure payment reduction to the “professional component” of CT, MRI, and ultrasound exams received by the same patient, on the same day, in the same setting in 2012. A 50 percent cut was included in the Centers for Medicare and Medicaid Services 2012 Medicare Physician Fee Schedule Proposed Rule. Bipartisan H.R. 3269 was introduced in the U.S. House of Representatives by Reps. Pete Olson (R-Texas) and Betty McCollum (D-Minn.). It was cosponsored by 31 House Members.
“This multiple procedure reduction and other imaging cuts are unnecessary and ill-advised. A published study shows that any efficiencies in physician interpretation and diagnosis when the same patient is provided multiple services in the same day are variable and, at most, one-tenth of what policy makers contend,” said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors. “Medicare funding for imaging has been cut seven times in six years, totaling more than $5 billion. Medicare spending on imaging is at 2004 levels and imaging growth is less than 2 percent annually. Further cuts would damage access to care for those who need it most.”
“Individuals that receive multiple imaging studies are often the sickest and most complex patients seen by physicians,” said Reps. Olson and McCollum. “They are typically affected by severe trauma, stroke, or widespread cancer. Imposition of this multiple procedure payment reduction would disproportionately affect the most vulnerable patient population. We strongly urge our congressional colleagues to support the Diagnostic Imaging Services Protection Act of 2011.”
Any imaging cuts, on top of those previous, would force many imaging providers to close and force imaging back into the large hospital setting, ACR stated. Medicare costs and patient co-pays are often higher for services provided in hospitals. Due to lack of access to imaging, more illnesses may not be caught until advanced stage -- raising treatment costs, affecting outcomes, and reversing gains against cancer and other illnesses.
A 2009 study for the National Bureau of Economic Research showed that increased use of medical imaging is directly tied to increased life expectancy for Americans. Those with less imaging access don’t live as long. A recent poll of registered voters showed that 70 percent of Americans oppose further Medicare cuts to medical imaging.
For more than 25 years, National Breast Cancer Awareness Month has
been a time to reaffirm our commitment to fighting breast cancer and to
remind ourselves of the importance of prevention and early detection.
Breast cancer remains one of the most frequently diagnosed cancers among
American women and despite remarkable advances in treatment and
prevention, it remains the second leading cause of cancer death. This
year alone, it is estimated that more than 230,000 U.S. women will be
diagnosed with breast cancer and nearly 40,000 will die of the disease.
Regular mammography screening can help lower breast cancer mortality
by finding breast cancer early, when the chance of successful treatment
is best. If 90 percent of women 40 and older received breast cancer
screening, 3,700 lives would be saved each year. Costs, even moderate
co-pays, deter many patients from receiving these important screenings.
Under the Affordable Care Act, women’s preventive health care -- such as
mammograms and screenings for cervical cancer -- is covered with no
co-pays or other out-of-pocket costs.
Read the rest of the secretary's statement here.