Whether you’re for or against health reform, there’s no escaping the major changes coming down the pipeline.
In the radiology field, there are more challenges than opportunities, according to Ben Isgur, director at PricewaterhouseCoopers’ Health Research Institute.
Isgur sees three major issues that will likely impact the bottom line for providers. The revised per-image reimbursement will be lower than in the past and will be based on a formula derived from a standard percentage of usage. Outpatient imaging centers that don’t utilize their scanners in high volume could see “pretty substantial cuts,” he said.
The federal government is also slashing its discount for single-session imaging based on the rationale that performing consecutive body part scanning should be easy, according to Isgur. Imaging centers will likely be forced to perform more scans in a single session to offset the discount reduction.
Lastly, physician self-referral – referring Medicare patients to get scanned by a machine in which he or she has ownership – must now be disclosed to the patient and physicians must offer alternative referrals. The change is partly in response to a GAO report that identified imaging as one area where healthcare costs are rising and the impact has increased substantially. Academic studies also show that there is a higher rate of utilization with physician-owned machines, Isgur said. “Most likely, the impact on providers is an administrative burden of having to have that conversation with patients and providing a list of local imaging centers,” he said.
All these changes combined, with the common denominator being lower reimbursements, the industry could see smaller imaging centers go out of business, merge or get acquired, Isgur said. The market is already being battered by the recession in the form of bad debt, decreased utilization and the rise of the uninsured.
The big opportunity with health reform is the influx of the newly insured, which could number 32 million, Isgur said. The deadline for having health insurance doesn’t begin until the start of 2014, making this a “delayed gratification,” he said. The increase in patients needing care can offset some of the reimbursement decline, but Isgur pointed out that the big question is can radiologists and imaging centers hold on for the next few years until the newly insured hit the market.
Isgur sees a long-term bright spot for the industry as substantial federal funding to the tune of one billion dollars is poured into health research, such as comparative effectiveness. Whereas imaging is seen as wasteful and a cost driver, imaging centers and radiologists have an opportunity to be seen in the same light as drugs in terms of detecting diseases and saving healthcare dollars. “They are in the position to be the alternative to more expensive care,” Isgur said.
