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ACA Impact Guesses: More Imaging, But …

July 5, 2012
Written by: , Filed in: Practice Management
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What does the Supreme Court’s upholding of the Patient Protection and Affordable Care Act (ACA)—or most of it, anyway—mean for radiologists? More business but probably less income, according to industry experts interviewed by imagingBiz.

Phil Russell, chairman and chief executive officer of Intrinsic Imaging in San Antonio, predicted a big surge in demand:

If you want to have greater volume, then I think the impact will be good to the point of being absolutely beautiful.

He elaborated: “With more Americans in possession of insurance coverage, we should all expect greater volumne of demand for radiology services. Through the narrow tunnel of radiology, this law will be good in keeping everyone in radiology very busy.”

However, Russell said, “More services will mean greater total expenditures in the aggregate, and higher total spending will crush taxpayers. The meager taxes, aka penalties, prescribed in the law for those who do not purchase real insurance policies will not begin to approach the added level of spending.”

That, he said, will lead to reductions in government reimbursement rates. “At that point, volumes will still be good,” he said, “but things could be bad for radiology because margins could be so slim as to make it an undesirable pursuit from a profit perspective.”

Jonathan Breslau, MD, president of Radiological Associates of Sacramento in California, said some practices could still benefit. For example, those with a significant volume of uncompensated care might see coverage at Medicaid rates for those who were previously uninsured.

That, however, depends on whether their state opts for the law’s expanded Medicaid coverage. The Supreme Court invalidated the ACA’s enforcement mechanism for the Medicaid expansion, so it’s now voluntary for the states. Up to half are expected not to participate.

“In Alabama, for example, about 16 percent of its citizens are currently uninsured, and nearly half of those would be eligible for new coverage if the state agrees to expand its Medicaid program,” Dr. Breslau said.

But he doesn’t expect that to happen. “Governor Robert Bentley is not supportive of any aspect of the ACA.”

Regardless of the ACA, Dr. Breslau said, radiologists’ compensation will decrease. “Now that the ACA will survive, hospital systems will move forward more confidently with new payment models, including ACOs and bundled payments, most of which will result in lower volume of imaging services and lower per-procedure reimbursement.”

Sounds gloomy. But Dr. Breslau did offer a ray of hope, sort of:

With the ACA, there will be lower gross dollars to radiologists. But without the ACA, there would probably be even lower gross dollars to radiologists. I guess that’s a positive.


Predictions about the ACA’s impact at this point are just guesses, some more educated than others. As the Supreme Court decision itself demonstrated, surprises are inevitable. Let’s hope at least some of them are pleasant surprises.

Related seminar: UCSF Radiology Review: COMPREHENSIVE IMAGING (all-new release; $200 discount if ordered this month)


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