CHICAGO—The Patient Protection and Affordable Care Act (PPACA) will likely mean severe cuts to imaging, a reduction in the advancement of imaging technology and pressure on radiologists to work for hospitals under an accountable care organization (ACO) model, according to a presentation on Nov. 28 at the 97th Scientific Assembly and Annual Meeting of the Radiology Society of North America (RSNA).
Bernard F. King, Jr., MD, of the Mayo Clinic in Rochester, Minn., explained that the PPACA came when it did as a result of rising costs, a rising number of uninsured people and a perception that insurance practices needed reform. In regards to cutting costs, government officials believed they could make cuts to imaging services without angering their constituents. In contrast, cuts to primary care payments are likely upset constituents, according to King.
One change that has already occurred is the coding for abdomen and pelvis CT scans. As of Jan. 1, the Centers for Medicare & Medicaid Services (CMS) combined the codes for these services, which severely cut reimbursement, as part of a mandate that says services performed together at least 75 percent of the time must use one CPT code.
King said that similar reductions will be likely as reform continues to be implemented. The PPACA gives the secretary of the U.S. Department of Health and Human Services the ability to identify codes that are misvalued, which will target codes characterized by fast growth and new technologies.
“The bottom line is what CMS will view as misvalued codes is code word for imaging and the high reimbursement for imaging that’s perceived by the government,” said King.
Reform will also mean the spread of the ACO model, and with it a pressure for radiologists to be employed by hospitals. The problem for imaging under an ACO is that the system of incentives is focused on the primary care doctor and leaves radiology out of the mix, said King. Shared savings will go to primary care physicians and the ability to manage image services will be weakened, as will technological innovation.
The U.S. Supreme Court will play a major role as it has announced it will rule on the PPACA in its current term, hearing arguments in spring 2012 with a decision likely in June 2012. King explained that the court will focus on four key points:
- The constitutionality of the individual insurance mandate;
- The constitutionality of the whole law should the individual mandate be severed;
- The ability of the court to even hear the case under a law which bars courts from hearing cases on taxes before they are collected; and
- The ability of the federal government to force states to expand their share of Medicaid costs at the risk of funding cuts if they refuse.
Should the law survive, King said a major focus of reform will be on comparative effectiveness research, and this is where imaging will have an opportunity to show that it can be a tool to save money.
“We just have to focus our efforts with the RSNA and with the American College of Radiology on looking at comparative effectiveness research and proving to those bean counters, to the government especially, and to insurance companies that imaging can actually reduce healthcare costs,” said King.