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Healthcare Economics & Policy

 

In its fourth annual update on medical overuse, JAMA Internal Medicine names 10 procedures and practices that are ripe for the curtailing. In the category of “overtesting,” the klieg lights fall on four exams—and all are based in imaging.

Anthem’s recent decision to no longer pay for outpatient CT and MR exams performed in hospitals didn’t come from nowhere—and, going forward, the move is not likely to be an outlier among private payers’ business stratagems.

In Harris County, Texas, three outpatient family-medicine affiliates of Baylor College of Medicine have slashed their unnecessary orders of lumbar-spine MRIs—and improved the appropriateness ratings of those they did order—by attending educational sessions and using the American College of Radiology’s R-SCAN program.

Offering first-year medical students an elective introduction to interventional radiology (IR), researchers at the University of Pennsylvania and its Perelman School of Medicine have found considerable receptivity to the learning opportunity and heightened interest in the specialty.

It’s no secret that radiology ranks among the medical specialties with the highest mean markups on list prices. However, a new review of Medicare data on prices listed and payments made shows that, far from being arbitrarily set—as is often assumed if not alleged—many of radiology’s highest prices reflect real-world, case-by-case factors involving heightened risk, greater clinical complexity and increased need for subspecialized expertise.

 

Recent Headlines

Inside the Economic Stimulus Package: What's In It for Imaging & IT?

This year, one trend dominates the health imaging market and the entire economy. The lingering and deepening recession stands at the top of the list of items that keep CIOs, hospital and clinical department administrators, and radiologists awake at night. There is at least a spark of hope in the $787 billion U.S. economic stimulus package. So whats in it for imaging, radiology, cardiology and IT? Health Imaging & IT untangles the package, interpreting its implications for the health imaging world.

Building Business: Adding New Imaging Service Lines

Community hospitals that add new clinical services to better meet local needs can garner multiple benefits ranging including improved patient care and increased revenue. This month, Health Imaging & IT visits a pair of community hospitals that added new service lines to their portfolio to better meet local needs. Their business models provide a sound roadmap for other sites.

Getting the Word Out: No-cost Marketing Strategies for Radiology

The halcyon days of ensured financial success simply by virtue of being the community hospitals radiology department are a thing of the past. Market pressures from independent imaging centers, other medical specialties utilization of imaging modalities, and targeted reimbursement cuts for imaging procedures from government and private payors require radiology departments to aggressively compete for patients.

Obama signs SCHIP into law, minus self-referral ban
President Barack Obama Wednesday signed a $32.8 billion bill to reauthorize the State Children's Health Insurance Program (SCHIP) for the next five years.
CMS guards $400M in improper Medicare, Medicaid and SCHIP payments
The Centers for Medicare & Medicaid Services (CMS) said it protected roughly $400 million of taxpayer dollars as improper payments for Medicare fee-for-service (FFS), a 3.9 percent decrease from 2007 to 3.6 percent, or $10.4 billion, in FY 2008.
Imaging Weighs the Evidence

Health imaging is one area of healthcare that has seen an unprecedented surge in utilization in the past decade. It is perhaps the fastest rising medical expenditure in the United States with an annual growth rate of 9 percent, nearly one-third more than the annual increase in general medical expenditures (approximately 6 percent). As such, policy-makers and payors are increasingly demanding evidence-based data to justify the utilization of many types of imaging procedures.

Reimbursement Update

The downs are outdoing the ups in radiology and radiation oncology reimbursement these days, but smart administrators can find some ways around the numbers.

Financing PACS: Balancing Financial & Technical Needs

Finding the best financial vehicle for PACS acquisition and implementation may be complicated, but researching the best-suitable option will likely bring long-term benefits.

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