Survival Strategies

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 - Mary C. Tierney
Mary C. Tierney

As the new year rolls in, we’re due to have a new healthcare reform plan—as well as an increase in the federal debt ceiling. My hope is the former brings good news for patients and the fiscal health of healthcare; the latter only means bad news.

Money woes are everywhere, from Wall Street to Main Street. For imaging providers, 2010 brings a change to the Medicare Physician Fee Schedule, which affects non-hospital-based imaging, as well as the widely debated increase in equipment utilization rates (of imaging systems more than $1 million) from 50 percent to 90 percent. Overall, CMS’ practice expense for radiology could drop 34 percent as well. (See “What Reimbursement Cuts Mean” on page 12.)

What will we likely see? Perhaps increases in self referral to keep business healthy or some non-hospital-based facilities opting not to serve Medicare patients.

To manage appropriate growth in radiology imaging and see that necessary studies are performed according to true need, radiologists need to be educators. If you look at a recent study of radiologists’ perceptions of physician ordering practices in Norway published in September 2009, the factors for increasing and unnecessary use of radiology services are modifiable (Study link:

Why is study volume increasing? New radiological technology and clinical indications top the list, followed by patient demands, clinician’s intolerance for uncertainty, expanded clinical indications and availability of technology and personnel, according to the study. And why are unnecessary exams performed? Over-investigation (to assure referring clinicians and patients), insufficient referral information and unclear questions in the referral were the most frequent causes. The results, as you may know, are consistent with similar studies—demand is driven by availability of services, supply of new technology and proximity to that technology. Patients are more aware, smarter and more driven to get the studies they believe they need. Physicians accommodate based on physician-patient relationships and fear of malpractice. Reductions in over-utilization can thus come via support to clinicians in the decision-making process, the authors say. Education on appropriate use is essential.

So what’s an imaging facility to do these days to survive?

Build better referrals. The radiologist-turned-business development manager needs to get out and promote specific services to generalists and specialists, detailing why they perform certain studies better than the competition, which patient populations and disease states are appropriate for those services, and how swiftness in scheduling the patient and turning around the report to the physician will benefit both. Supply and demand go hand in hand.