Radiologists look out for number one during healthcare reform

July 6, 2009

Let’s face it. Our current healthcare system has dealt most of the winning cards to radiologists. Radiologists hold some of the best paying jobs in medicine. The hours are regular. The time off for continuing education and other nonclinical pursuits is generous. And the opportunity to work mainly in an outpatient setting can lower professional anxieties considerably.

Let's face it. Our current healthcare system has dealt most of the winning cards to radiologists.

Radiologists hold some of the best paying jobs in medicine. The hours are regular. The time off for continuing education and other nonclinical pursuits is generous. And the opportunity to work mainly in an outpatient setting can lower professional anxieties considerably.

It is a great job that reaps generous benefits . . . at least in the healthcare system as we know it. (Chronic complainers can direct their e-mails to me at james.brice@cmpmedica.com.)

What will happen after healthcare reform is anybody's guess, though the aforementioned reasons give radiologists good reasons to be defensive.

A review of what happened in 1993 when then-president Bill Clinton attempted comprehensive reform is instructive. I recall attempting to calm our radiologist readers about the prospect of losing 20% of their incomes. That percentage was cited frequently during the debate.

The cut was deemed necessary as part of the attempt to level the playing field between radiologists and other "haves" of the prereform system and the "have nots," mainly primary care physicians. That shift never happened because the 1993 reform effort failed. Radiologists remained financially healthy and happy, and primary care M.D.s continued to be overworked and financially frustrated. After 17 years, that remains the status quo.

I'd guess that radiologists will not be so lucky this time around.

The relevant question is not how to prevent damage, but how to minimize it. For an answer, we need only look to the American College of Radiology, the profession's main lobbing force in Washington, DC. It is clear from discussions with ACR lobbyists that the big picture of healthcare reform, whether all Americans are covered and whether a public insurance option is essential, is secondary to their main concerns. They want to minimize the financial losses for radiologists and maximize the quality of imaging practices in whatever type of reformed system emerges.

On the financial side, radiology's forces are against an upward adjustment in the assumed utilization rate for CT and MR in Medicare's relative value formula. A higher utilization rate would mean a lower reimbursement rate. The ACR opposes a proposed increase in the discount for CT imaging of contiguous body sections. And it backs American Medical Association efforts to turn away from the sustainable growth formula for Medicare that will lead to draconian rate cuts for physicians if it is not changed.

On the quality side, the ACR supports mandatory accreditation and more use of appropriateness criteria. It proposes decision-support order entry as an alternative to radiology benefit management companies and imaging prior authorization.

The priority list is short, but it is focused. It suggests that if radiologists are concerned about the overarching issues driving healthcare reform, they should not look to the ACR to advocate lofty goals. For that, they should write their senators and representatives directly.

But they can rely on the ACR to protect their pocketbooks and to fight for high imaging standards. Again, letters and e-mails to elected representatives in Washington will help radiology's cause.