News item: At the urging of the ACR, Representatives Henry Waxman (D-CA);  Sandy Levin (D-MI); and Pete Stark (D-CA) recently called on the General Accountability Office (GAO) to study the effects of medical imaging self-referral and radiation therapy treatments on Medicare spending.

In what I can only see as ironic—oh, and it’s about time, too—Stark is finally looking into cleaning up a mess of which he is one of the chief architects. The so-called in-office exemption to federal self-referral and anti-kickback laws in Medicare were born from what ware once commonly called the Stark I and Stark II laws in 1992 and 1994. The in-office exemption was one of the widely discussed safe harbors for physicians in the federal antikickback law. Part of its purpose was to serve as a cookie for procedure-based physicians who were seeing their procedural reimbursement cut under the RVU-based Medicare Fee Schedule that was supposed to provide a boost primary care physicians and evaluation and management services.

Sixteen years later, the gap between primary care and specialist income is no better and self-referral is one major driver of upward spiraling healthcare costs. Holy unintended consequences, Batman!

After national publicity, Congressional hearings and FDA investigations, regulatory changes tightening the approval process of linear accelerators is coming from the FDA, as reported in this article from New York Times investigative reporter Walt Bogdanich. Bogdanich researched and reported a lengthy series of articles on the topic that pushed radiation exposure into the publich eye. Organization in radiology and radiation oncology had been working on radiation exposure issue before these articles appeared, but they undoubtedly served as catalyst to the present scrutiny.

Lt. Col. Anthony Terreri, MD, a radiologist serving in the U.S. Air Force, thought the piece of shrapnel looked a little odd on the CT images. It turns out that the lipstick-shaped object was an 2.5 inch unexploded shell embedded in the serviceman’s skull. Read this interesting article and see the CT image in this report from ABC News.

Saw this report on NBC News about lung cancer:

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“I think of it as a critical first step in making a healthcare system that works for all Americans. It’s not the only thing. We’re still going to have adjustments made to further reduce costs…”

— President Barack Obama, in a televised interview with NBC’s Matt Lauer

Signing the healthcare bill (including the so-called fixes) into law only starts the process of making needed changes in the American health system. While I agree with the President that it’s a much-needed first step, that “we’re still going to have adjustments made to further reduce costs,” is an epic understatement.

The new law’s impact on health insurance reform should expand access and secure coverage for high-risk populations, but it does little to reduce the cost of healthcare. Long-term cost control is a must-have for this reform effort to be considered a success. The heavy lifting to achieve that objective really hasn’t begun yet. Congress and Obama’s first step does force everyone on both sides of the aisle into the game. Republicans need to avoid being seen as obstructionists and begin participating and influencing the change. There’s still a big split over how to reform healthcare, but the President’s approval rating jumped five percentage points since the bill was passed. Now that the law is on the books, Republicans run the risk of it being successful and the GOP being seen as watching history from the sidelines. Democrats need to make reform workable and affordable or risk being swept out of office. Both jobs seem sizable.

On a more practical level, the regulations that will implement the new law are already beginning to be developed. Secretary of Health and Human Services Kathleen Sebelius announced this week that the law’s regulations affecting insurance companies would be released “shortly.”

Anyone who pays attention to healthcare politics realizes that the rulemaking process defines how laws will be implemented. The American College of Radiology (ACR) is working to influence areas that affect the imaging community. The ACR Web site lists the following as key areas where healthcare reform affects medical imaging:

• Increase in the Medicare utilization assumption rate

• Increase in Contiguous Body Part Discount Rate

• Self-Referral Disclosure

• Appropriateness Criteria Study

• Exclusion of USPSTF Mammography Screening Guidelines as Basis for Coverage Decisions

• DXA Reimbursement Adjustment

• Sustainable Growth Rate Fix

Details on ACR’s lobbying efforts in these areas are available on the college’s Web site.

Thomas Scully, a former White House healthcare advisor to the first President Bush, told attendees at the Society of Interventional Radiology meeting in Tampa yesterday, that he expects the House of Representatives to pass the Senate version of healthcare reform, possibly by this coming Saturday.

Scully was part of the panel in the session, “The Evolution of the Economics of Modern Medicine—IRs Revolutionizing the Practice of Medicine,” He told the audience that he believes President Obama and Speaker of the House Nancy Pelosi will muster enough support to pass the bill by a very narrow margin. Scully said the Obama administration has so much invested in healthcare reform that it will get the Senate version passed by the House and signed into law.

Scully, who said he is an advocate for universal coverage, said the Senate’s reform bill is more moderate than the House version and the country and healthcare system will be marginally better off for it. His view is that there are both good and bad aspects of the Senate bill. Scully, who called himself a moderate republican, said the country probably would be better off if it had passed a bill similar to the Clinton administration healthcare plan in the 1990s. He noted that the actual core of the Clinton plan was similar to the changes to the insurance system included in the senate plan.

He said he would not be surprised if the House passes the Senate version but does not pursue with further changes using the controversial budget reconciliation process. Scully noted that the passing the bill could possibly cost Democrats control of the House of Representatives in the November elections, and will likely cut into its majority in the Senate. He surmised that by passing the bill and moving on to other initiatives, Congressional Democrats might think they can minimize voter anger at their inability to effect the promised change that swept them into power in November.

Five major CT scanner manufacturers announced yesterday that they will implement radiation protection software on their systems, according to this Associated Press article. GE Healthcare, Siemens, Philips, Toshiba, and Hitachi will introduce and deploy software that sounds and alarm when the dose delivered exceeds the scanner’s maximum recommended level.

It’s not the complete solution, but the move absolutely is a positive step and smart move for the industry.

Thirteen large radiology groups — encompassing more than 750 radiologists — on Wednesday announced the formation of a consortium called Strategic Radiology.

According to the Strategic Radiology Web site, the practices included in the clinical and non-clinical collaboration performed 11.6 million exams and procedures and served 124 hospitals.

“Our vision is for Strategic Radiology to deliver efficient world-class patient care through clinical and non-clinical collaboration,” Strategic Radiology’s chairman Arl Van Moore, MD, said via the organization’s Web site. Moore is the immediate past president of the ACR and chair of Charlotte Radiology in North Carolina.

Exactly how the groups will work together clinically and economically remains to be seen, but the idea of a physician-owned, privately held so-called super group is one way to compete in the evolving world of radiology services. Will the cooperation include shared overnight and specialty reads? How about collaboration for pursuing contracts? Cooperative purchasing? Shared IT support in some capacity? There good questions about how this will evolve—and how it fits into the future of delivering radiology care.

Strategic Radiology’s press release touts its intention to remain both privately held and physician owned. Such an organization has the potential to put physician-owned entities on more competitive economic footing with public telerad groups and corporate imaging entities. As groups increase in size and smaller practices feel the pressure to grow or be pushed out of the way, this could prove a viable strategy. But small groups banding together might not be an appropriate analogy. The mean size of each group involved in Strategic radiology is 59 radiologists.

It’s too early to tell what this consortium will bring, but it’s worth paying attention to new models of radiology practice.

Strategic Radiology Member Groups
Advanced Diagnostic Imaging—Nashville, Tenn.
Advanced Radiology Services—Grand Rapids, Mich.
Austin Radiological Association—Austin, Texas
Charlotte Radiology—Charlotte, N.C.
Diversified Radiology—Denver, Col.
Inland Imaging—Spokane, Wash.
Jefferson Radiology—Hartford, Conn.
Mountain Medical Physician Specialists—Salt Lake City, Utah
Northwest Radiology—Indianapolis, Ind.
Radiology Ltd.—Tuscon, Ariz.