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Radiologists Will Have To Prove Their Value

November 8, 2012
Written by: , Filed in: Practice Management
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What is the value of  radiology? If radiologists can’t assertively answer that question as we move into an era of bundled payments, then they’re going to take a big financial hit.

The Affordable Care Act (ACA) didn’t start the push toward bundled payment models, but it certainly accelerated it. With President Obama re-elected and Democrats retaining control of the Senate, the law may be tweaked, but it won’t be repealed.

So insurers, both private and public (Medicare, Medicaid), will increasingly be saying, “Here’s a lump-sum payment for all of the treatment that Jane Doe received during her latest encounter with the health-care system. All of you who were involved in that treatment can decide among yourselves how to divide the money.”

And that lump sum will be significantly less than what would have been paid in total to all of the providers under fee-for-service.

Therefore, said radiologist Frank Lexa, MD:

We have to think hard about how radiology provides value and how you get paid because in many groups there is going to be a paradigm shift.

Dr. Lexa is a professor in the department of radiologic sciences at Drexel University in Philadelphia and the author of the “Profiles in Leadership” series of articles in the Journal of the American College of Radiology. He was quoted in a thoughtful—and worrisome—”what’s next for imaging?” interview by Loren Bonner of DOTmed News.

Regarding the ACA, Dr. Lexa said, “Certainly the bill has not been kind to us, and the ethos in the bill is very much a transfer of power from practitioners to hospital entities but also from specialists to primary care doctors.”

The federal government is pushing payment and treatment models, such as accountable care organizations, that encourage a team approach to medicine. Paradoxically, however, those models could tear teams apart if primary care doctors and various specialists all start fighting for shares of a shrinking reimbursement pie.

Radiologists need to protect their financial interests, Dr. Lexa said:

One of the questions for ACOs is, is if you’re not going to be paid more to do more, then where is radiology going to be? Instead, we have to look at the value radiology brings to patients and the medical organization. The challenge for our generation is going to be how to show value to the people who are writing the text for this.

Related seminar: UCSF Radiology Review: COMPREHENSIVE IMAGING


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