American College of Radiology blog

Is Radiology Recession-Proof?

As more Americans are feeling the effects of the economy, it should come as no surprise that people are opting out of health care. The primary reason? Costs.

A survey of 12,000 Americans released last week found that about 20 percent of Americans have skipped medical care. About the same percentage thought they would have a difficult time paying for medical care in the future. However, only about 8 percent of those surveyed indicated skipping some form of medical imaging. More than half said they skipped a doctor’s visit.

Does that mean that Americans value medical imaging over a visit to their primary care doctor? That would be hard to determine from this one study. But it is something to think about.

The College is interested in knowing what you think.

• Has your practice or hospital experienced any effects from the economy?

• Or, have patients cancelled any imaging studies due to costs?

I look forward to hearing your thoughts.

Savings Through Spending: Obama’s Budget Announced

On Thursday, President Obama announced his $3.6 trillion budget plan for the 2010 fiscal year. The plan would create a “health care reserve” costing $634 billion over 10 years, in an effort to provide universal health coverage. Tax increases and cuts to Medicare and Medicaid would fund the reserve.

According to the plan, increased spending on insuring all Americans upfront will save money in the long run, because patients will seek out care and engage in preventative measures to reduce the occurrence of chronic (and often costly) diseases.

The proposed plan would seek to control imaging costs through the use of radiology benefit management companies in the Medicare program. The ACR, however, has argued that the use of Appropriateness Criteria in an order entry system is a better way to monitor imaging, and ensures that patients receive the best study for their condition in a timely manner.

Other health care measures in the plan include:

• $1 billion to the FDA to improve food safety
• $6 billion for cancer research
• $76.8 billion toward EMR adoption and medical treatment comparison
• $330 million toward addressing doctor and nurse shortages

What do you think about the budget plan in terms of health care reform?

What do you think are the strengths and shortcomings of the plan?

I look forward to your comments.

Preauthorization of Imaging — Cautious or Controlling?

The recent Associated Press article "Health Insurers Limit Advanced Scans" was in the forefront of medical news recently, published in hundreds of newspapers nationwide and on countless Web sites.

The article highlighted the preauthorization process for many diagnostic imaging procedures instituted by some private insurance companies, citing soaring costs and radiation concerns as sources of their scrutiny.

Preauthorization may help these payers save money and may help some patients avoid unnecessary exams. However, it does not address self-referral, a primary driver of increased utilization and the quality and safety concerns associated with imaging performed by poorly-trained providers.

Also, the lag time for even certified radiologists with expert knowledge to receive approval for a necessary examination has the potential to deter physicians from ordering what they believe to be the most appropriate exams, for fear of the claim being rejected or the decision reversed after the scan has already been completed.

With the cost of the medical imaging skyrocketing, it’s no surprise that payers are taking a hard look at our field. Instead of criticizing the health insurance companies for doing what they may believe is a service to patients (in addition to saving them money), the College is working to better educate them regarding which tests are appropriate and when.

A fact based foundation for preauthorization is the ACR Appropriateness Criteria®, which Dr. Bettman pointed out in response to Dr. Thrall’s recent blog post. ACR accreditation can be an alternative quality assurance measure.

How have you managed preauthorization in your practice and how do you think the ACR can lead efforts to help ensure safe, effective, necessary imaging for patients in the future? Please remember that any comments will be in the public domain and your name will be posted along with your comment.

I look forward to your thoughts.