Radiology leaders react cautiously to Obama’s healthcare plans

Radiologists reacted cautiously to healthcare reforms proposed Wednesday night by President Barak Obama in a speech before Congress. They were heartened by his remarks supporting screening mammography and malpractice reform, but they said the proposal doesn't change much in terms of lobbying direction or provide all of the details they are waiting for.

Obama said a reform plan must include mandatory coverage for preventive care like screening mammography and must eliminate waste in Medicare. He also said steps would be taken to explore different approaches to tort reform and acknowledged malpractice-caused defensive medicine may be boosting healthcare costs.

New language from Obama reversed his longstanding opposition to medical tort reform. At a minimum, he promised to support a plan initially backed by former president George W. Bush to sponsor demonstration projects that explore different approaches to malpractice reform.

"Many in this chamber, particularly on the Republican side of the aisle, have long insisted that reforming our medical malpractice laws can help bring down the cost of healthcare," Obama said. "I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.

"I know that the Bush administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my secretary of Health and Human Services to move forward on this initiative today," he said.

Reforming malpractice laws is an opportunity to decrease the number of unnecessary tests, including imaging tests, according to Dr. Michael Graham, president of SNM.

"I'm sure a lot of imaging falls into the category of defensive medicine," he said. "My colleagues said they think around 10%."

Dr. James Thrall, president of the American College of Radiology, remains skeptical that malpractice reform will end up in the final bill considering Democrats have a tendency to oppose the issue and have clear majorities in the House and Senate.

"In Washington, everything is negotiable. Everything is a compromise," Thrall said.

If tort reform ends up in the final bill, it could save the healthcare system anywhere from $100 billion to $200 billion a year in unnecessary procedures, lab tests, and hospital admissions, Thrall said.

"I'm hopeful Obama got the message: many of the savings necessary to pay for healthcare reform could come from tort reform," he said.

The ACR will continue to focus on closing loopholes in the Stark laws and decreasing the overutilization of imaging due to self-referral, Thrall said. Obama's address doesn't change that.

"Because [Centers for Medicare and Medicaid Services] and Congress are unwilling to take on the self-referring community, they've resorted to reducing the per-unit reimbursement for high-tech imaging," he said. "It hurts the ethical providers as well as the self-referring providers."

Self-referral drains money out of the healthcare system and provides no benefits to patients, Thrall said.

When it comes to eliminating waste from Medicare, cost-effectiveness and comparative-effectiveness studies will be invaluable, Graham said.

"I hope we don't get regarded as so expensive they need to get rid of us," he said.

It will be crucial to prove radiology's cost-effectiveness in order to keep a situation like that from occurring.

SNM is setting up a task force on cost-effectiveness studies and hopes to schedule a meeting with the Agency for Healthcare Quality and Research in the spring to discuss the issue.

"It's going to be quite important to demonstrate real effectiveness of studies for relevant communities," he said. "We need to do a better job of that."

The focus on early detection and preventive care is a boon for breast imagers, who have long advocated this position, said Dr. Phil Evans, president of the Society of Breast Imaging.

Many radiologists are waiting to see what goes into the final healthcare reform legislation, since Obama's speech didn't go into specifics.

"I think this plan is driven by the details and that's where this plays out," said Dr. Brian Stainken, president of the Society for Interventional Radiology.

Radiology groups agree a comprehensive reform bill is likely to come out by the end of the year.

What is your position on the health reform plan? We'd like to hear what you think should be included and excluded in the legislation. What needs to be done to protect radiology's interests and advance the goal of more accessible and affordable healthcare? Transmit your comments to DI news editor Jim Brice at james.brice@cmpmedica.com.