Considering the financial and professional implications of reform, it is not surprising that radiologists and imaging service providers are anxious about where the political discussion will lead.
Cynicism permeates the comments of 19 respondents to the DI healthcare reform survey who accepted our invitation to express their opinions. While generally supporting increased access and private insurance reform, they fear increased government involvement will produce a bureaucratic mess.
Roughly organized by subject, here’s what they had to say:
GENERAL - CRITICAL
- I believe that the healthcare reform bill will substantially overburden the healthcare sector while not reimbursing the physicians and hospitals appropriately. Quality of care will decrease significantly, and healthcare staff will be overwhelmed with problems that are faced with a lack of resources for such dramatic growth.
- Good luck with it, ACR, I'm taking down my shingle in a couple years.
- We radiologists are a bit greedy.
GENERAL - SUPPORTIVE
- Healthcare reform is necessary for this country. Imaging has been riding a high horse and it’s time to come down to reality. The abuse must stop and fair compensation must be given.
ACCESS / PERSONAL RESPONSIBILITY
- Education, prevention, and early detection of illness are the best tools for reducing healthcare costs and improving outcomes. In the most medically advanced country in the world, no citizen should be denied treatment because of money.
- What we need is insurance reform, not healthcare reform.
- We need an alternative health insurance in addition to that which is available, for the individuals who are not employed by companies and for the uninsured in general. There needs to be an alternative to those who have preexisting conditions who are deemed uninsurable. Shareholders need to be put out of the equation, so that more of the monies put into the insurance may actually go towards patient care.
PUBLIC INSURANCE OPTION
- Oversight is good. Government-run healthcare is not good for the people as a whole. How can I believe in such a change when I see all the waste, fraud, and cost with Medicare and Medicaid? And who would vote for government-run healthcare after being aware of the faults in the veteran’s medical system?
SELF-REFERRAL / APPROPRIATENESS
- Radiology is most important, explosively more effective with modern technology, and explosively more expensive. We must expose and reduce the conflicts of interest in self-referral and in specialty-controlled self-policing. Self-referral reform needs to be in place
REGULATING IMAGING REIMBURSEMENT
- I'm very concerned about the direction this reform seems to be taking. Imaging is a primary tool for providers to use in the diagnosis of the disease processes. To limit payment will be to limit access. It will make two levels of care-one for those who can afford to pay for their tests and [one for] those who must rely on some form of government guidelines that may be controlled by nonmedical gatekeepers. Very Scary!
REGULATING IMAGING DEMAND
- Patient demand should be checked by the referring M.D.
Has anyone ever compared the total administrative overhead cost of CMS with total expenditures by Medicare for diagnostic imaging on a state-by-state basis? The inefficiency and ineptness encountered when trying to obtain any type of information from Medicare should not be tolerated. The sheer amount (and mindless redundancy!) of paperwork for something as routine as a change of address is staggering.
And get ready for a whole new set of gatekeepers to diagnostic imaging: small service providers like my company. CMS has actively begun requiring us to prove the medical necessity of procedures ordered on patients in their homes or at nursing facilities. If CMS decides the study was medically unnecessary, we are flat out of luck, because, according to CMS, we should have known in advance the study was medically unnecessary. I did not go to medical school and certainly do not feel qualified to query the doctor about his or her decision before responding to the patient's bedside. Furthermore, I don't sleep well at night knowing that CMS thinks I should.
If Congress would follow suit with every business entity in U.S. and take a chainsaw to administrative overhead, we might be able to save money and just let doctors be doctors again. As a patient, I have a ton of respect for the 10 to 20 years of advanced schooling and ungodly tuition my doctor had to invest to become a board-certified internal medicine specialist. I hope to heck she makes a fortune in her practice, because she certainly deserves it.
As the owner of a small mobile imaging practice, I am the one on the phone with a frantic nurse at 10 p.m. on a Saturday who has an elderly patient, fresh out of hip replacement surgery, whose painful swollen leg was negative for DVT four days ago, but whose swelling looks worse and [on whom] the doctor needs a venous study done STAT. And I know that I'm going to respond and do the study and pay the tech and the radiologist and the transcriptionist, and then get a letter from CMS wanting the clinical notes and reasons for the repeat study, and wait for the review process, and then maybe get paid for the study 120 to 190 days later or file an appeal. And in the interim, I can't help but wonder how much CMS charged for all the administrative effort to push back a payable 120 to 190 days.
Who was it who always closed his column with, "And so it goes"?