Denial, Disbelief, and Anger

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One can no longer sugarcoat or deny the fact that radiology is a profession under siege. Many of those that I met with this past year across the country were scrambling simply to make sense out of the DRA cuts and in the process find ways to offset the financial hit. Most were a little stunned but held out hope that our industry representation in Washington, DC, would use its influence and skills to, if not outright reverse, at least delay such a draconian act. Hope faded and turned to denial and disbelief. So here we are now in the first month of our new world order and it is anger that is starting its slow burn. For me it started with the dashed hope that the "big tent" coalition known as the Access to Medical Imaging (AMIC) group would somehow use its purported Washington clout to bring reason to those legislators who seemed bent on, in the words of the coalition's leader Tom Scully, "whacking imaging." As the press releases continued their steady drumbeat of cost cuts, rate reductions, and "adjustments," it seemed that health care in general was under assault. Added to this was the uncertainty surrounding the impending physician fee schedule conversion factor reduction and it seemed as though everyone was getting whacked. In the end, there were winners and losers, and radiology was not among the winners. The physicians dodged a bullet on the fee schedule adjustment primarily because the American Medical Association is a very strong lobbying organization. One felt the onset of "clout envy." Then, an article in the Los Angeles Times on December 21st really turned up the heat on the slow burn. Titled "Congress closes with a pork-filled flourish," the article's lead paragraph stated that "Christmas arrived Wednesday for the kidney dialysis industry….when legislation approved by the outgoing Congress included a $100 million-a-year boost in the Medicare reimbursement rates for dialysis providers." Don't get me wrong, I am happy for the dialysis providers. They deserve the money. The part that got me worked up was the following quote from the same article: "The dialysis earmark, like other nuggets in the bill, had not been authorized by a congressional committee, and its addition to the tax bill was made final in a secret middle-of-the-night meeting in the waning hours of the session on Dec 7th. Dialysis scored 'not because dialysis patients have the most meritorious case,' said Sara Rosenbaum, professor of health law and policy at George Washington University, but because the industry 'is effective on Capitol Hill.'