The annual meeting of the Radiological Society of North America (RSNA) was held from December 1 through December 6, 2013 at McCormick Place in Chicago, Illinois. Once again SteleRAD was there to listen and contribute to the discussion surrounding key medical and legislative developments in radiology. The following are a few key takeaways from the RSNA annual meeting.
Challenges Created by the Affordable Health Care Act
The Affordable Health Care Act is presenting both new challenges and new opportunities throughout the health care community. The practice of radiology will change from a financial perspective, due to the transition from fee-for-services payments to bundled payments.
This change could mean that radiologists will get lost in the shuffle and their worth not recognized, unless they change the way in which they run their practices and present themselves to other members of the medical community. Dr. Jeffrey Levin, one of the presenters at the RSNA, states radiologists can increase their visibility by becoming more involved in hospital strategic planning, attending medical executive committees, and helping to control overall hospital costs.
In addition, Dr. Levin states that radiologists should undergo a culture change and become more like consulting physicians. He recommends taking a leadership role in checking exam orders for appropriateness, giving patients access to their test results, supervising advanced radiological procedures, and consulting with referring physicians.
The challenges associated with the Affordable Health Care Act present opportunities for radiologists who can change their style to reap the benefits of the new system.
Take Patient Care Further Than Interpreting Images
The Affordable Health Care Act will bring additional challenges to the field of radiology, and radiologists themselves may have to become more involved in patient care than ever before. Radiologists now should become active and integral players in all aspects of the radiology imaging process for patients. Many patients do not even know who their radiologists are, except by a name on a medical bill.
Radiologists now have to own all aspects of a radiology practice: scheduling, billing, image interpretation and even the design of the waiting room. All these variables combine to form a patient’s perception of a radiology practice, and could be the difference between a repeat customer or a patient going elsewhere.
Practicing patient-centered care is a major way for radiologists to increase their visibility, proving their worth to the medical community as well as the patients they treat.
Greater than 25 Percent of Emergency Radiology Procedures Uncompensated
The overall use of medical imaging services is declining; however, the use of medical imaging services in emergency rooms is rising, and many of the procedures being performed on an emergency basis are going uncompensated.
Dr. Richard Druszak Jr. of Emory University School of Medicine in Atlanta states that over 25% of radiological exams performed on an emergency basis go uncompensated. Dr. Druszak also states that given the safety net that is common among emergency rooms nationwide regarding uninsured patients, this problem of uncompensated services affects a great number of specialists, particularly radiologists.
The overall effect of this overcompensation could mean that patient access to much-needed emergency radiological services could decline if not recognized by hospital policy makers and regulators. Emergency CT scanning accounts for approximately one-third of all uncompensated emergency radiological services, but accounts for nearly two-thirds of all uncompensated dollars.
Radiologists Can Play Pivotal Role in Reducing Patients’ Radiation Exposure
As the number of emergency radiological procedures grows, so does the amount of radiation in which emergency room patients are exposed. An emergency room physician’s normal screening exams are X-rays and CT scans, both of which expose patients to ionizing radiation.
Dr. Mark D. Hyatt of Regence Blue Cross and Blue Shield of Utah states that his group has contracted radiologists to consult with ordering physicians in order to reduce the number of unnecessary CT scans and X-rays. They frequently consider alternate means of imaging, such as ultrasound and MRI, when applicable. Dr. Hyatt states that in a two year period, subscribers to Regence Blue Cross and Blue Shield were spared the radiation dose equivalent of 7 million X-rays because CT scans and X-rays were switched to MRI or ultrasound.
Reduced exposure to ionizing radiation can be greatly beneficial to the overall health of a patient, which is why medical facilities should monitor and document the number of radiological procedures a patient has undergone. As radiologists and referring physicians begin to work together, the exposure to ionizing radiation can decrease, increasing the overall quality of care to the patient.
How Radiologists Will be Affected by Meaningful Use Legislation
Meaningful Use legislation mandates that all physicians and hospitals use electronic health records to generate orders and track all patient demographics (height, weight, medical history, smoking history, etc.). The main focus of this legislation is to ensure that the patient is receiving the highest quality of care, based on this data. At the beginning of 2015, physicians who have not invested in electronic health records or conformed to the Meaningful Use guidelines may incur a decrease of Medicare reimbursements, due to lack of compliance with this legislation.
From a hospital-based radiologist perspective, these physicians commonly do not have access to the entire medical history of the patient, nor are they involved with follow up treatments of the patient. However, many hospital-based radiologists still invoice their services, and don’t actually collect a salary; therefore, a reduction in Medicare reimbursements could mean a drastic decrease in income.
Currently, hospital-based radiologists are exempt from Meaningful Use legislation, though the exemption is set to expire at the end of 2014. At present, most are recommending a “wait and see” approach, until either a decision is made to extend the exemptions, or to require hospital-based radiologists to invest in electronic health records.