PPACA Is Unlikely to Dramatically Affect Imaging Volume, But a Deeper Cost Focus Is Probable

By Cat Vasko

On June 28, the Supreme Court ruled that the individual mandate contained in the Patient Protection and Affordable Care Act (PPACA) is not unconstitutional, interpreting it as a tax. Based on the mandate, in 2014, US residents will be required to buy health insurance (or will face a tax penalty that will slowly increase over time). Pat Basu, MD, MBA, CMO of Virtual Radiologic (vRad) and a former Obama-administration White House Fellow, says, “The eventual positive impact on utilization could be large, but you will not see 30 million additional insured patients in early 2014. The fine in the first year is relatively low, so I think a lot of younger individuals just won’t comply.”

Further, Basu predicts, the impact of the mandate on imaging might be small, at first. “The primary age group we’re talking about is between 26 and 45, and that age group is currently not using much medical imaging—but its members are also the fastest-growing users of it,” he says. “In the near term, the PPACA may not have a gigantic effect on radiology practice patterns. In the long run, however, it almost certainly will.”

CHCs and Imaging: Precursors of the PPACA Model

By Cat Vasko

Community health centers (CHCs), established by the federal government as part of a 1975 legislation package, have spent 37 years trying to solve one of the primary problems tackled by the Patient Protection and Affordable Care Act (PPACA): keeping underserved or uninsured patients out of emergency departments through the provision of affordable preventive care. Today, more than 8,000 CHCs across the country provide health care to over 20 million patients.

Donna Rosenlieb, RT, a registered diagnostic medical sonographer who serves as radiology supervisor for the Community Health Center of Central Wyoming (CHCCW), says, “Our mission is to be the stopgap for the underinsured and uninsured—to keep them out of the emergency departments. Without us, there would be nowhere else for them to go.”

Subspecialization in the Crosshairs: Imaging and the MPPR

By Cat Vasko

In July, CMS released its proposed 2013 Medicare Physician Fee Schedule¹ (MPFS). Contained within its pages was an unpleasant surprise for imaging: the reintroduction of the Multiple Procedure Payment Reduction (MPPR) last seen in the 2012 proposed rule. As Maurine Spillman-Dennis, MPH, MBA, senior director of economics and health policy for the ACR®, explains, “They had pulled back the group-practice provision, but now they have put it down as a proposed policy again. We got a reprieve, but now it’s back.”

The group-practice provision would apply a 25% reduction in professional-component reimbursement to any second study performed for one patient at the same practice on the same day. The reduction applies “even if it’s a different modality, even if the interpretation is completely different, and even if you’re dealing with two different reports and the findings need to be communicated twice,” Dennis says.

Matt Cox, vice president of business development for Virtual Radiologic (vRad), adds, “We would agree with the ACR that this appears to be a blind cost-cutting initiative on the part of CMS. We think reduced reimbursement for radiologists who are, for instance, diagnosing multiple traumas in a patient’s noncontiguous body parts represents a failure to recognize the dynamic nature of radiology.” >> Read More

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