Attention to the Smallest Details
As radiologists, we are trained to pay attention to the smallest details, whether it is a questionable shadow on a mammogram or an abnormal feature on a CT scan. Suffice to say, our professional integrity and success is based on our ability to notice the smallest details. We cannot simply give an image a cursory glance and proclaim a patient healthy; we must be certain that we have looked carefully for the slightest irregularity.
Likewise, today's health care environment requires us to be not only part-time medical economists, but we must be able to detect, interpret, and, more important, understand the smallest details in many of the legislative and regulatory proposals that impact the economic health of our profession.
For some time now I have emphasized the need for us, as the nation's recognized imaging specialists, to work vigorously to address the unrestrained growth in the inappropriate use of diagnostic imaging. This issue is a critical item not only among our legislators and in the portentous Centers for Medicare and Medicaid Services (CMS) hallways, but among the third-party payers as well. These escalating costs must be reined in and we, as radiologists, must ensure that the issue is addressed in a way that guarantees the continued recognition of our professional and economic security. These groups are looking to us for a modicum of guidance and counseling, and we must not waste the opportunity.
However, we must carefully evaluate each and every proposal, whether it originates with Congress, CMS, or a third-party payer, to ensure that it is fair to radiology before we endorse it. As with a diagnostic image, we cannot give a cost-saving proposal a passing glance and proclaim that we support its goals. For example, earlier this year CMS proposed reducing reimbursement for contiguous body parts that are scanned by the same cross-sectional imaging modality on the same day. The proposal, which has also been considered by some payers, would reimburse the highest relative value unit in full, but would reduce the reimbursement for other contiguous body parts by 50% and affect only the technical component and not the professional component.
Sure, this would significantly rein in diagnostic imaging costs, but it is far from fair to our profession. Not only does this proposal show that the rulemakers do not fully comprehend the application of modalities such as CT, MR, and ultrasound and that the economies vary between modalities, it does not take into account the potential injurious impact on the quality of care patients receive as hospitals and other facilities refrain from investing new capital to ensure their imaging departments offer the latest technology.
In the coming months, we will see countless proposals from various government sources and third-party payers, as each one hurries to address this critical cost issue and, in many instances, may be asked to offer our evaluation—and potential approval—for any number of proposals. Yet, we must continue to heed the small details within a proposal and be alert for the slightest economic shadow or financial abnormality that could potentially be debilitating to the profession to which we have dedicated our lives and our energies. I assure you that the College staff and leadership through our Government Relations and Economics Commissions will remain vigilant on behalf of our patients and our members.