Radiology finds reassurance on sunny side of change

November 6, 2008

Change may be the byword for the historic election of Sen. Barack Obama as president, but the type of change Obama will bring to the White House won’t necessarily be accompanied by the uncertainties and anxieties that come with a sharp departure from the past.

Radiology has already had more than its share of uncertainty in recent months. Markets for new projects have evaporated as reimbursement rates have been cut, the growth of imaging services revenue has slowed, financial capital is scarce, and potential investors have lost confidence in the economic engine of medical imaging technology.

Obama’s election and the prospect of healthcare reform can help break through that malaise, not add to it. As we noted in our October cover story, Obama’s path to healthcare reform is clear and should evoke confidence. It revolves around the inclusion of 47 million uninsured U.S residents and the maintenance of healthcare access to the 8% or more of them who are or soon will be unemployed.

Obama-style healthcare reform is founded on the bedrock of employer-sponsored health insurance. His blueprint does not fiddle with the plans or the underlying employer tax benefits for health insurance that covers 61% of the population.

Imaging practitioners can be assured that the Democratic-controlled Congress will at a minimum approve federally subsidized insurance assuring healthcare access for all the nation’s children. Access to affordable healthcare coverage is now a stronger possibility for all workers in the U.S. and their families as well.

Greater access can mean only one thing for radiologists and other medical practitioners: Demand for their services will rise. Imaging volumes, especially for basic radiological services such screening mammography, ob/gyn ultrasound, musculoskeletal CT, and MRI, will increase. Universal access to health insurance in Massachusetts has shown that the demand for healthcare services is always greater -- and, unfortunately, more expensive -- than planners anticipate. If implemented, healthcare reform will represent full employment for this and future generations of radiologists.

Imaging equipment will be fully employed, and new equipment will be needed. Demand will be great for PACS and teleradiology networks to link imaging data to electronic medical records, whose implementation is the expected target of billions of dollars of federal expenditure. Efficiency and productivity will join with quality as the watchwords of imaging practices.

Healthcare reform will also certainly bring a downside for the imaging community. Emerging imaging technology will be examined with more scrutiny. The clinical usefulness and cost-effectiveness of new applications will have to be more clearly established before they are reimbursed.

We can probably also expect utilization to undergo even closer scrutiny than it is getting under our current system. Note that utilization management companies already cover 109 million lives in the commercial marketplace. This expansion, however, may also provide a benefit if it assures that only the most qualified individuals -- radiologists -- control imaging equipment and provide imaging interpretations.

The bottom line is that diagnostic imaging provides a real value to the healthcare system. Steps toward healthcare reform will certainly increase scrutiny of imaging practices. But if imaging strategies are found to be valid, and we are confident they will be, any system that expands access to care will also expand opportunities for imaging vendors, facilities, and radiologists.

The demand for new equipment will grow swiftly to meet new demand from populations that before now have not been served by our healthcare system. This demand for new imaging equipment could stir a resurgence of the medical imaging manufacturer sector and soften the pessimism that has darkened radiology since the Deficit Reduction Act rate cuts were implemented two years ago.