The Outpatient Imaging Forecast Is Mixed, but Growth Is Ensured

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In November 13, 2008, GE Healthcare, Waukesha, Wis, hosted a webinar entitled Interpreting the Future of Medical Imaging. Offering insights into the future of the field were Bob Maier, president and CEO, and Brian Baker, senior vice president, Regents Health Resources, Brentwood, Tenn.

Imaging will continue to grow, although the path to prosperity may include several obstacles, according to Maier, who adds that the playing field is leveling for all imaging providers. Among the key points presented at the outset were that all imaging operators will require accreditation by 2011, that both provider-based reimbursement and the DRA lesser-of fee schedule will grow by 3% in 2009, and that there will be an increasing focus on quality.

Maier shares the view of Daniel R. Levinson, inspector general, DHHS, who believes that imaging growth in the next five years will be fueled by research and its application to existing technology.

The 2009 reimbursement landscape will show a slight recovery from the DRA cuts mandated in 2006, and volumes will continue to rise. In 2009, Medicare-allowed services for advanced imaging (MRI, CT, and PET) are expected to increase by 9.7 million procedures, while allowed charges for the same will amount to $4.32 billion. As a ratio of charges to services, this is consistent with each year’s ratio since the enactment of the DRA.

Not all the news is good, however. In 2007, utilization was up 3.2%, but expenditures were down 12.7%. Among the challenges on the horizon is the cost of health-insurance premiums, which between 2002 and 2007 grew 4.4 times as quickly as the inflation rate and 3.7 times as quickly as wages.

This dramatic rise in premiums is already forcing more US residents to abandon health care coverage altogether or to assume greater control over their coverage by opting out of employer-subsidized programs and shopping for insurance privately. Often, the lower premiums of private policies are supported by higher deductibles, forcing consumers to pay out of pocket for medical services until the deductible is reached.

As this trend continues, consumers will increasingly shop by price for their medical services, including imaging. Transparency, then, will become an increasingly important imaging development.

Despite this development, hospitals continue to invest in imaging technology. In a poll of 1,282 critical access hospitals across the country, Regents Health found that over the next three years, hospital investment in additional technology or in upgrades will continue to rise:

Services Add Technology Upgrade
MRI 11% 13.4%
CT 4.9% 28%
Ultrasound 6.1% 25.6%
DR 3.4% 24.4%
Catheterization lab 2.4% 0%
Digital mammography 36.6% 23.2%
PET/CT 7.3% 2.4%
Bone densitometry 15.9% 12.2%

That hospital investment will continue to rise may be disconcerting to partners in imaging center environments, which face their own set of challenges. These include radiology benefit management pressure, a shortage of capital sources, increased hospital competition, the need for service differentiation, stand-alone contracting disadvantages, an aging technology base, effective use of IT technology/tools, and reimbursement-reduction pressure from payors.

While the current economic climate is creating a buyer’s market, Maier and Baker shared the results of a Regents poll indicating that those who are interested in expanding through mergers and acquisitions will have a more difficult time finding financing. Nonetheless, this scenario bodes well for the private-equity and venture-capital–funded imaging organizations that wish to grow over the next five years, Maier and Baker believe.

All providers of imaging, however, will find that challenges abound. Maier and Baker identify the following challenges that will apply universally to all providers. There will be a lack of radiologists to handle the volume. At the 35th annual meeting of the American Healthcare Radiology Administrators, Frank Lexa, MD, MBA, described estimates of a radiologist shortage through at least 2020.

There will also be a lack of staff and qualified managers. As technology advances, so will the need for knowledgeable staff. Reimbursement will equalize with pricing transparency. Pricing structures may pose a unique challenge in the years ahead. Quality differentiation will be vital. Imaging centers, hospitals, and others will have to define their advantages more clearly to their referrers and to the public.

Precertifications will need to