An brief article on AuntMinnie.com reports that next year’s imaging  reimbursement cuts—if Congress takes no action and accepts the administration proposals—would be larger than the 2007 hits from the implementation of the Deficit Reduction Act. The analysis from 3D Health, Inc. calculated that technical component reimbursement cuts would drop 38% for CT, 31% for MRI, and on down to 4% for ultrasound.

We don’t yet know what the final reimbursements will be, but further cuts would spur volume increases by providers, which has been the universal response to reimbursement reduction since cavemen were given three rocks instead of five rocks for a mastodon pelt. The increased hunting by the procedure-driven cavemen led to mastodon extinction. You can look it up.

If a picture is worth a thousand words, an image with a little narration is worth much more—especially to your referrers. Last year at RSNA, Greg Rose, MD, President and CEO of NightRays teleradiology service, excitedly showed me an easy-to-use tool that combines a PACS workstation’s diagnostic images, the cursor movement and the radiologist’s dictation into an mpeg file for referring physicians and their patients. Check out Rose’s intro to VidRay and the first VidRays archived on the Radiology Today Web site.

A CBS News report suggested that 35% of diagnostic scans are unnecessary and that the U.S. could  save $35 billion per year by cutting out those exams. The video and online article reported the diagnostic imaging costs the U.S. $100 billion per year.

“It’s too easy, too fast, too good. So it’s much easier to order the test than it is to observe the patient, to monitor the patient, and avoid doing the CT scan,” radiologist Steve Birnbaum, MD, told CBS. One major focus of the article reported how Birmbaums daugher had nine CT scans done during her one-week hospital stay after a car accident, before he interceded out of concerns for unnecessary radiation exposure  and exams. The overutilization theme corroborated by Yale School of Medicine radiology professor Howard Forman, MD, MBA. Read the rest of this entry »

Here’s an interesting take on imaging self-referral and defensive medicine played out in comments to a recent article in the New York Times:

“At the turn of the 21st century, the journal “Health Affairs” published a list of the most important medical developments of the 20th century. Three of the top ten were diagnostic imaging examinations. Thus, growth of these procedures is understandable. But we need to be responsible about their use.
Think about it: There exists a marvelous tool that is also expensive and carries potential risk. Yet we let people oversee and profit from its purveyance even though they are not trained in its use or safety. This is not in the public interest. All doctors and policy makers should agree that the personal economic incentive to order imaging (indeed, ANY) tests should be eliminated PERIOD. Just as the government should not tolerate giving defense contractors carte blanche to add on expenses to their projects thatr accrue directly to them, neither should the “medical contractors” have that privilege.”

Here is an interesting article from The Washington Post on The Mayo Clinic and healthcare reform. Frequently touted as a low-cost, high quality model for providing care, The Mayo Clinic has been mentioned numerous times by President Obama in his reform drive. This article raises interesting questions about whether the Mayo Clinic successful approach is a reproducible model for healthcare.

Mayo clinic doctors are paid salary rather than fee for service. Proponents argue that this change provides incentives to provide efficient, quality care, rather than just a high volume of procedures. Detractors say the Mayo model isn’t broadly applicable, according to the Post article because “Mayo’s patients are wealthier, healthier and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.”

The debate continues…

The Baucus Bill contains two paragraphs about malpractice reform.

Sense of the Senate Regarding Medical Malpractice

Current Law
No provision.

Chairman’s Mark
The Chairman‘s Mark would express the Sense of the Senate that health care reform presents an opportunity to address issues related to medical malpractice and medical liability insurance. The Mark would further express the Sense of the Senate that states should be encouraged to develop and test alternatives to the current civil litigation system as a way of improving patient safety, reducing medical errors, encouraging the efficient resolution of disputes, increasing the availability of prompt and fair resolution of disputes, and improving access to liability insurance, while preserving an individual‘s right to seek redress in court. The Mark would express the Sense of the Senate that Congress should consider establishing a state demonstration program to evaluate alternatives to the current civil litigation system.

What It Might Mean. It might mean anything. It probably means you shouldn’t expect any change in medical malpractice and liability insurance any time soon.

Here’s the blog’s first look at the healthcare reform bill offered by Senate Finance Committee Chairman Max Baucus (D-MT), also known as The America’s Healthy Future Act of 2009. Legislators on both sides of the aisle seem dissatisfied with it, often a sign that it has a chance to find its way into law.

I’ve gone through 233-page bill and sought out key provisions related to diagnostic imaging. I’ll include the text of the bill for those sections and added what it might mean to imaging. In the coming days, I’ll follow up with how the general provisions of the bill (for example, general Medicare reimbursement provisions.) would be affected. In case you don’t speak Washington gobbledegook, the “Chairman’s Mark” means the new bill’s provisions.

Have a look and let us know what you think. Read the rest of this entry »

Here’s some potentially good news for proponents of  malpractice law changes finding their way into the healthcare reform debate. MedPage Today posted an article Friday reporting that Sen. Kent Conrad (D-N.D.) told reporters that Senate Finance Committee members are drafting reform legislation including a section on malpractice. Sen. Max Baucus (D-Mont.) said the committee plans to introduce a bill next week.

“The issue of limiting malpractice insurance premiums, through caps on jury awards or other means, is as dear to the hearts of Republicans and many doctors who support them as the status quo is to Democratic stalwarts and the trial lawyers who support them,” the MedPage Today article reported. “So the mention of malpractice this week is significant, given Obama’s previous dismissal of the issue and the fact that none of the other congressional committees had included any medical liability language in their respective bills. It may have triggered some momentum to include malpractice issue in healthcare reform.”

Healthcare needs to remain on the table so pressure builds on lawmakers tackle this issue.