That is so yesterday

January 8, 2004

By Greg Freiherr, Editor, gfreiherr@cmp.comIt's the new year. Some things that are gone should stay gone. But I doubt they will. The Medicare Prescription Drug, Improvement

By Greg Freiherr, Editor, gfreiherr@cmp.com

It's the new year. Some things that are gone should stay gone. But I doubt they will. The Medicare Prescription Drug, Improvement and Modernization Act of 2003, signed into law several weeks ago, will see to that.

Throughout this legislation are references to quality care, cost-effectiveness, and efficiency. Each is an excellent goal-except when the government gets involved.

I learned two things in the decade I spent in government consulting. First, quality to those in the Federal bureaucracy is defined by the simple phrase, good enough is good enough. There's no sense striving for better. In the government, cream does not rise to the top. It curdles wherever it's found.

Second, when something goes wrong, the first priority is finding someone to blame. I am convinced that many people in government believe finding fault is the solution.

Which brings us back to the Medicare bill. Crafters of this legislation hope to encourage healthcare providers to improve the way they do business by offering rate increases for inflation to those who improve quality and cost-efficiency. The criteria for deciding whether these goals have been met are up in the air. And that could be a big problem.

Unless the radiology community takes hold of this situation immediately, there will be a price to pay and it could be a doozy. In this, the first year of this legislation, Medicare is going to be generous and spread its inflation adjustments to the deserving and undeserving alike. In the second year, providers will have to document that progress on the CMS mandate is being met. If not, the hunt will begin for those at fault and, if the past is any indication, radiology will be among the usual suspects. Better be ready.

Fortunately, radiology has never been in a better position. Advances in CT and MR in stroke and trauma, fledgling prospects for these modalities in cardiovascular imaging, and the very real progress that's been made with PET/CT in cancer patient management provide ample ammunition against anyone who comes after the specialty. More can be said in radiology's favor for increased productivity and improved efficiency, apparent most clearly in the dramatic growth in patient throughput. But these facts will work only if they are used properly.

Vendors and providers need to put their heads together now to come up with a plan for documenting how imaging equipment that costs millions of dollars is the best bargain on the planet. This plan will be needed and it will be needed soon.