CHICAGO — While changes, and challenges, in the U.S. health care delivery system have typically been attributed to the Affordable Care Act, many of these changes would have happened regardless, said Thomas W. Greeson, JD, at RSNA 2014.
The ACA accelerated this activity, Greeson noted, but it has long been a suspicion that the contributor, or possibly the culprit, of the high health care cost is the fee-for-service system. Medicine needs to find alternative payment models.
“And that’s happening with our without the ACA,” Greeson said.
Health plans are actually thriving under the ACA, Greeson said. With the creation of new programs and participation in the exchanges, health plans are creating ‘narrow networks’ to try to increase their profitability, he said. By contracting with hospitals or physician practices, they can shop around for the best prices and the best quality, Greeson explained.
“The concept of managed care has always been about selective contracting,” he said. “You participate with a private payor in a managed care plan only if you are a participating provider. The narrow networks are a new breed of selective contracting, which we now refer to as selective contracting on steroids.”
Radiologists need to get in on this. They, as physicians, have been particularly impacted by the inability to participate in a payment plan, Greeson said.
“If you are not part of every payment plan in your community, and you are competing with the imaging center across the street that is participating in all of those plans, it’s much easier for the referring physicians to refer their patients to the center that’s part of all of the plans,” he explained.
Radiologists need to align themselves with groups that contract with every single payor.
“It’s never been more important,” he said.
Radiologists can no longer preserve their autonomy. The effort to maintain independence must be exchanged with growing and building relationships with hospitals, and then demonstrating value.
“Whatever it is that you choose to be a part of,” Greeson said. “If you can actually build your relationship and demonstrate your value, you [can have an] ally at the negotiation table when working on those bundled payment negotiations.”