The Knowns and the Unknowns

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 - Claudette Lew
Claudette Lew, Associate Editor

What do we really know? As former Defense Secretary Donald Rumsfeld once said: “We know there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are things we know we don’t know. But there are also unknown unknowns—the ones we don’t know we don’t know.”

Healthcare today is in the midst of an evolution. We are defining our knowns and unknowns and evaluating uncertainty from the provider’s perspective.

As decision-makers and business operators and optimizers, radiologists are proceeding with caution—navigating the knowns of the situation at hand. They measure, monitor and keep watch over the practice, ever-focused on long-term sustainability. Analyzing data to recognize trends, manage revenue and minimize loss helps radiologists stay on top of the changes we know are on the horizon, such as ongoing cuts to reimbursement and the rollout of ICD-10 coming soon. We know what we know.

As the March 31 st deadline for open enrollment in the health insurance exchanges (HIEs) arrives, soon we’ll have a handle on enrollment demographics. Just last week, CMS announced that more than 4.2 million individuals have enrolled in the new plans. Understanding this new and rather large patient population, we’ll have a better idea of how patients’ health profiles, based on their demographics, will affect radiology utilization and revenues. There are new opportunities for tools like predictive analytics to offer business intelligence to inform decision making at the practice level. Predictive data analysis will help radiology and other specialty practices remain viable and even assist in demonstrating value in each patient’s health journey. We will soon know what we don’t know now.

But there are plenty of things we don’t know we don’t know. This first full term of the HIE will establish the baseline against which we will benchmark patient participation in the HIE plans and Medicare expansions, the effectiveness of the plans themselves, the effects on utilization rates for radiology and other specialties, overall, as well as specific reductions in healthcare costs (and the increases, too), access as well as new barriers to care, and the plans’ overall effect on health outcomes. This is the blind spot. Surprise appeasements such as the expected extension to the grandfathered policies that don’t meet the requirements of the new plan only serve to subvert the administration’s vision for the new healthcare law by succumbing to pressure from influential third parties. Decisions about future participation in the plans by insurers also will affect the balance of the new environment—they will be evaluating the level of increased (or decreased) potential for expansion and profitability gained through their participation in the HIEs.

Despite the knowledge quadrants we find ourselves in, radiology moves cautiously onward, collecting data to inform decision making, and continuing to provide the highest quality care while maintaining successful business operations.