There’s no question imaging technology has far surpassed expectations, but the business of radiology is evolving every bit as rapidly. Reimbursement cuts, higher deductibles and the Affordable Care Act are challenging current business models and changing the landscape of radiology.
So how are Nashville’s radiology leaders handling an inevitable industry-wide evolution?
Clete Madden, COO at Brentwood-based Touchstone Medical Imaging, said today’s radiology practice is a whole new ballgame from that of years past.
“You’ve got to do things faster, better and with higher quality,” said Madden, whose radiologists see 1,200 patients a day at Touchstone’s 36 locations nationwide. “You have to look outside: at other potential structures, ventures and partners, and work collaboratively under regulations with hospital systems and large physician groups.”
Cuts & Co-pays
Among radiology’s most recent changes was the 2014 Medicare Physician Fee Schedule, which decreased payment to providers by nearly 20 percent for many procedures. (Some saw a slight increase, while more common tests – CT and MRI – took the biggest hit). It also lowered the interest rate assumption for purchased equipment and increased the equipment utilization rate from 75 to 90 percent for MRI and CT.
Another pinch felt industry-wide is the challenge of recovering payment from healthcare’s newest payer: the patient. As more Americans opt for high deductible plans, providers can no longer afford to write off co-pays without taking a substantial hit.
Making it Work
With so many cuts – and more anticipated with 2015’s Physician Fee Schedule – how do radiology practices stay afloat?
Kirk Hintz, CEO of Nashville-based Radiology Alliance, said the private practice is focusing on quality improvement and technology utilization to become more efficient.
“We’re seeing a shift from volume to value-based healthcare and don’t really have a full handle on what that means yet,” Hintz said. “That’s a lot to digest from a practice standpoint, but what we’re looking at is trying to drive value back to the system, carriers and patients.”
To that end, Radiology Alliance has implemented double-blinded, peer review studies for 5 percent of all cases, improving quality and value proposition in a competitive marketplace. They’ve also invested in zVision, an innovative software offering from Clario Medical designed to ease radiologists’ workloads, create work lists and manage workflow across systems.
Similarly, Madden noted, “We’re seeing a lot more dedicated analytical approach to monitor quality, including a more efficient use of information technology. We’re looking at a more formal approach to patient satisfaction measurement.”
He also anticipates further consolidation of smaller radiology practices driven by accountable care organizations, the ability to leverage and negotiate, and the need for consistent quality across the continuum of care.
In the midst of ongoing regulatory changes, radiologists also are spending more time consulting with referring physicians. Both Hintz and Madden said their radiologists welcome these discussions and often are called upon to educate providers on best practices in the rapidly changing field.
“They’re very concerned about making sure the right procedure is performed at the right time,” Hintz said of his 40-plus radiologists. “We work with hospitals to discuss correct protocols in lowest doses to obtain the highest quality.” Providing more education and fewer tests with the least amount of doses has become a national effort, resulting in initiatives like Image Gently and Choosing Wisely. (See related story on page xx.)
Another challenge for radiologists is the temporary lack of reimbursable codes for newer modalities like tomosynthesis — a 3-D technology that provides Radiology Alliance patients with clearer breast scans. While approved by the U.S. Food and Drug Administration, tomosynthesis is not yet considered the standard of care for breast cancer screening.
“Some practices wait for reimbursable codes before getting technology, but we look at what’s best for the patient and how it will help our partners,” Hintz said.
Radiology & the Stark Law Loophole
Another goal for radiologists is to better educate CMS and payers on imaging practices. As a whole, Madden said radiology lacks the big lobby and extra funds needed to fight industry-wide cuts.
However, one initiative gaining momentum on Capitol Hill is a proposal supported by the Association for Quality Imaging (AQI) petitioning Congress to adopt provisions in the FY2015 budget. Their goal is to close the in-office ancillary exception for advanced diagnostic imaging services … essentially, to eliminate self-referring non-radiologists steering patients toward their own in-office equipment rather than advanced diagnostic centers. According to the AQI, closing the loophole would save $6.1 billion over 10 years.
Madden, an AQI board member, claimed the prevalence of in-office imaging violates the original intent of the exception to the Stark Law, which was to provide limited incremental services in a physician’s office, such as blood draws, basic lab work and small x-rays for same day patient convenience. According to the AQI, “broad cuts by CMS have not targeted the actual ‘over-utilizers’ – i.e. self-referring physicians, but have incentivized those physicians to make up for the lost revenues from CMS cuts by directing more patients to their own imaging equipment.”
Closure of the loophole would be a huge win for radiology practices but a blow to specialists who offer imaging in-house. An online statement from the American Society of Nuclear Cardiology (ASNC) asserts: “Congress and regulatory agencies should focus on the promotion of high quality, accredited imaging regardless of the site of service. Moreover, ASNC regards patient choice as a fundamental tenant of the healthcare system. The removal of the in-office ancillary exception may drive patients to a hospital setting, disrupting established physician-patient relationships and subjecting patients to higher co-payments.”
It’s just one more piece of a very complex puzzle affecting millions of patients and providers nationwide.
“As we look to the future, radiology is a specialty that touches all departments, which makes it one of the most unique specialties,” Hintz concluded. “We’re uniquely positioned and endowed with a great responsibility as we transition to a future beyond where we imagine we can go.”
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