Q&A | Imaging Insiders: Reimbursement & Reform Top RBMA Agenda
Q. What is the top business challenge radiology faces today?A. Reimbursement is the top concern. We're seeing a continued downward trend in reimbursement for the technical component, and now the professional component seems to be in the mix. It's very difficult to maintain an imaging practice when reimbursement rates are not even at the breakeven point for some studies.
Q. How are practices responding to the downward trend in reimbursement?A. There are shifts in the outpatient market. Some practices are considering provider-based restructuring, selling outpatient imaging centers to hospitals, and others are trying to maintain market share. Unfortunately, moving to a provider-based solution is not always the best option; there are many factors to consider.
Q. Can you elaborate on issues related to provider-based imaging?A. Selling an imaging center to a hospital because of perceived advantages may backfire. If the local market is saturated with freestanding imaging centers, managed care organizations and radiology benefit management companies will steer radiology studies to a lower cost provider. Managed care companies in California, Florida and New York, as well as most urban areas, can choose from multiple imaging centers and will gravitate to the lowest cost provider.
Outpatient centers should undertake a thorough analysis, perhaps using an outside consultant before moving forward, as this needs to be weighed against the associated costs and administrative burdens to comply.
Q. How is healthcare reform impacting the radiology business?A. Previously, to address improper or under-valued Medicare reimbursement rates, the radiology industry submitted comments and data regarding the impact of reimbursement changes to the Centers for Medicare & Medicaid Services (CMS).
The Patient Protection and Affordable Care Act (PPACA) ties a portion of imaging reimbursement to this legislation. The radiology industry must now reach out to not only CMS, but to Congress as well, to secure changes in imaging reimbursement. This is much more difficult than working with CMS alone.
The other major issue is current meaningful use criteria. There are no meaningful use standards or measures relevant to radiology. Plus, there are no certified radiology EHRs, and radiologists have no control of the software a hospital may purchase and use.
RBMA is working with other organizations to study meaningful use standards as they evolve and will comment to the U.S. Office of the National Coordinator of Health Information Technology and CMS when appropriate. It may be more advantageous for radiologists to not qualify for bonus payments on the front end, and also not be held to penalties on back end.
Q. How is the RBMA addressing these issues?A. RBMA needs to be involved, engaged and proactive. We're trying to work with our legislators and CMS to educate and inform them about the issues, the impact to the small businesses we call medical practices and the long-term effects to patient care and overall healthcare costs.
RBMA is moving forward on data-driven initiatives to use on the advocacy front. Data are going to drive the conversation going forward and provide the evidence needed to enact change. The only way we're going to modify regulations impacting radiology is by providing accurate, relevant and understandable data.
RBMA continues to focus on educating our members and the radiology industry about emerging practice models, new payment models, compliance and coding and building the practice leaders of tomorrow.
Finally, we have a tremendous responsibility to educate legislators regarding the importance of radiologists and their role in the continuum of healthcare, the difference between hospital-based and hospital-employed physicians and the need to maintain outpatient imaging facilities for the convenience and cost effectiveness of patients.