Among the 11 ideas for bending the cost curve in health care offered in the latest issue of the New England Journal of Medicine are several that directly concern medical imaging providers -- most notably the proposal to institute competitive bidding for all “commodities” and create price transparency for consumers.
While many radiologists will take issue with the idea of imaging services being perceived as a commodity, the number of notable names among the authors signing on to this idea may give pause. The authors include:
- bioethicist Ezekiel Emanuel, M.D., Ph.D.
- former CMS administrator Donald Berwick, M.D., M.P.P.,
- economist Michael Chernew, Ph.D.
- former Senate majority leader Senator Tom Daschle, (D-SD)
- economist Peter R. Orszag, Ph.D., of the IOM
In addition to advocating for competitive bidding for imaging and eliminating barriers to price transparency (such as insurance company contract "gag clauses"), the article proposes greater use of bundled or global payments, including for cancer care.
The authors also push for legal and regulatory changes. They say the exception to self-referral rules that allows physicians to provide “in-house ancillary services,” such as diagnostic imaging, in their own offices should be eliminated. In addition, they propose that safe harbors from malpractice suits should be expanded so that physicians that follow national guidelines and best practices — like the recently developed Choose Wisely guidelines for 45 common tests and procedures that might be overused — have some protection from lawsuits and do not need to engage in “defensive medicine.”
The article, "A Systemic Approach to Containing Health Care Spending" was among the three most-read stories on the NEJM website this week. To read it, click here.