Don’t Fear the Reaper

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I first started writing about radiology in 2006, when the hot topic was, of course, the DRA. It was the first in a seemingly endless series of blows to radiology’s reimbursement that would hit in the ensuing half-decade. Unlike my colleagues Cheryl Proval and Curtis Kauffman-Pickelle, who have both witnessed plenty of ups and downs over their time in this industry, I’ve never known radiology when it wasn’t in crisis mode.

The doom-crying was pretty heavy-duty back in 2006, so I hope I can be forgiven for having wondered, as an imaging naïf, what I’d gotten myself into. Of course, if I’d first started writing about this industry last week, I’d have wondered the same thing. It seems like every new year marks a fresh opportunity for us to number our woes. Reimbursement’s always getting worse. Or is it?

An article in the February issue of ImagingBiz.com breaks down the reimbursement changes in the 2011 MPFS, with somewhat surprising results. It turns out that a small handful of codes, along with the MEI rebasing, are entirely responsible for the net downturn in payment. Most radiology codes were actually adjusted upward this year, and the MEI rebasing was, of course, applied across the board – imaging’s not feeling any unique pain on that one.

Sure, the codes that were impacted are some of the biggies, payment-wise: CT of the abdomen and pelvis, angiography. But any code that represents a whale for radiology also represents a whale for those who would chip away at radiology’s control of imaging—in other words, physician self-referrers. By de-incentivizing them to unfairly and inappropriately dole out these services, the MPFS does everyone a favor. With enough volume, imaging will be able to weather the change. Self-referrers skimming the occasional study off the top? Not so much.

There’s always a bright side. In the past five years I’ve seen imaging cope with a lot of deleterious changes, but I’ve also seen the industry enhance its focus on access, appropriateness and safety. Would these topics have risen to the forefront if not for imaging’s need to prove its worth? Maybe not, or at least not in such a coordinated, structured fashion. But by forcing us to stake our claim, the government also forces us to become better than ever at what we do. And the best part is, we keep proving that we can do it – can provide better, more coordinated, more appropriate care while tightening our belts. We have the ingenuity to make it happen.