Economics ’09: House (and Senate) of Horrors?
“Hope we don’t scare you too much before Halloween,” cracked program director Lawrence R. Muroff, MD, as he kicked off Thursday’s opening session of the Economics of Diagnostic Imaging 2009 conference. “But turbulent times [are] ahead.”
He wasn’t telling the 180-plus attendees anything the symposium’s subtitle--“Strategies for Success in an Uncertain Economy”--didn’t already portend. Clearly, neither Dr. Muroff nor any of the other speakers at the 24th annual conference in Arlington, Va., were interested in fear-mongering. Quite the contrary. Their take-home message was this: Don’t be afraid; be prepared.
No one’s quite sure how looming health care reform will impact the medical imaging profession, as components of the plans being bandied about by the House and Senate are in a state of constant flux. “No [plan] will simultaneously decrease cost, increase access, and do all the wonderful things we hope for,” said Frank J. Lexa, MD, MBA, clinical professor of radiology at the University of Pennsylvania Medical Center, who outlined the impact of the 2008 election on radiology practices. Dr. Lexa, who’s also an adjunct professor of marketing at the Wharton School, said the state-level health care reform passed in 2006 by Massachusetts--a reform that is now marked by nine-digit budget shortfalls that are expected to surpass $1 billion by 2010--foretells what could occur after federal reform is passed. Dr. Lexa also said he’s concerned regarding the long-debated public option, which he feels could push out private insurers in a decade. With some form of sweeping reform primed to pass in the House and Senate without the need for a single Republican vote, Dr. Lexa urged radiologists to prepare for continued revenue reductions; re-evaluate costs, contracts and service offerings; and increase their political and societal involvement.
That last sentiment was echoed strongly by Dr. Muroff and David C. Levin, MD, FACR, professor and chairman (emeritus) of the department of radiology at Thomas Jefferson University Hospital. Support a Congressman through individual and societal campaign contributions, he said, and your legislative concerns will be heard. “It’s a sad thing that our democracy is for sale,” said Dr. Levin, “but money talks.” Dr. Muroff added that the trial lawyer wife of one prominent radiologist once told him she was shocked that individual radiologists don’t contribute more money to candidates. If they did, she said, they would be a nigh-unstoppable political force. “The bottom line is, it’s appalling what we [radiologists give],” said Dr. Muroff. “We should expect what’s being done to us at the state and federal level.” Dr. Levin did offer a few encouraging developments for radiology, however. They included an increased awareness on the part of a few legislators regarding the ills of self-referral; and the required accreditation (courtesy of the Medicare Improvements for Patients and Providers Act of 2008, or MIPPA) for all providers of advanced imaging by 2012.
The American College of Radiology (ACR) hopes to become one of those accrediting organizations, said Harvey L. Neiman, MD, FACR, executive director of the ACR. Outlining the College’s legislative initiatives for health care reform--which include expanding the use of appropriateness criteria as an alternative to the controversial radiology benefit managers (RBMs)--Dr. Neiman remarked, “We have no allies … it’s us against the world, and that presents significant problems for us.” His remark elicited knowing chuckles from the audience. Relating a recent meeting with representatives of the Obama administration--which has proposed $260 million over 10 years to support RBM preauthorization in Medicare--Dr. Neiman observed, “The administration clearly has its agenda … I’m [just] not sure it’s in the direction we would agree with.”