by Richard Toren

March 2012 -The Affordable Care Act has had a tectonic change effect across all segments of healthcare. Hospitals have become “health systems” through acquisitions of other hospitals, absorption of physician practices, and movements to accept total risk as if they were insurance companies. At the same time, there have been wholesale purchases of EMRs by physicians and hospitals to take advantage of Meaningful Use stimulus payments.

In radiology, reimbursement changes began even before Obama signed this landmark legislation, with contiguous organ reductions and the combining of nuclear and ultrasound codes without adding in the Relative Value Units (RVUs) of the dropped codes. The diagnostic fee schedule has also seen decreases. What’s more, hospitals have had a good ROI buying imaging centers because of the big differential between the APC fee schedule and the technical-outpatient part B payments.

While most won’t outwardly admit it, radiologists have been easy prey for these changes for several reasons:

1. They don’t have direct relationships with their patients and therefore have little effect on direct referrals.
2. Specialists have long used the “ears” of their congressional patients to push their agenda. The radiologist’s voice has been left out of the dialogue.
3. Historical dictations that combined reads for multiple, contiguous organs were a lightning rod for fee reduction. The mistaken assumption was that there weren’t additional RVUs.
4. Imaging studies are often duplicated, since there is no open data exchange for providers to check whether a patient’s recent images may be available.

UnitedHealthcare recently announced a new method of paying providers to incent savings and then share those savings with participating providers. As part of the statement of sources of potential savings, radiology was front and center. Unnecessary procedures, duplicates, high income, etc., were all stated.

Many radiologists believe ordering physicians are a major cause of problems that hoist blame on the radiologists. CPOE was supposed to help this problem, along with providing better utilization review. However, it seems that these measures have only increased costs by paying for technology and more front desk work.

It doesn’t have to be a dire message for radiology, though.

What if radiology were an important part of cost reduction and savings? Picture alerts designed and developed by radiology. How about an app on an iPhone or Droid with instant feedback from a radiologist when an order is sent, indicating that either a different order is recommended or an existing imaging procedure was performed two weeks ago? The question could also be asked about the condition or presenting problem that is being studied, so the radiologist can act more consultatively. The app could be downloaded from the radiology market directly.

Let’s have the American College of Radiology (ACR) get in front of this and advocate separate cost sharing for radiology, since they are the only ones that can effect this kind of major change in ordering and movement of images. The ACR could go to payors and negotiate new contracts upfront after conducting a demonstration project at a major institution.

All this means getting in front of the solution and not whining about the problem.

About the Author

Richard Toren founded and currently serves as Chairman and President of CodeRyte, Inc. The rapidly growing firm offers physicians and hospitals software solutions for extracting billing codes from transcribed clinical records. Prior to CodeRyte, Rick served as President and COO of QED Solutions, Inc. where he directed the software firm’s growth in marketing data analysis software for pharmaceutical corporations to detect causal relationships with adverse events.

Earlier in his career, as founder and CEO of Promedco, Inc., Rick managed and owned outpatient imaging centers in five states. Promedco was sold to Vivra (NYSE), where he served as President of the newly subsidiary, Vivra Heart Partners, and grew the medical management business to a $55 million company. He subsequently founded and served as President of e-Medx. Inc.

In addition to his current responsibilities at CodeRyte, Rick also gives his time serving in various board member roles with the American Heart Association and Christiana Care Health Inititives hospital system. Other charitable activities include the National Federation for Teaching Entrepreneurship (NFTE) for inner-city high schools and Support Entrepreneurship teaching at Georgetown and American University. He also served as the DC Chapter President of Ronald McDonald Children’s Charities from 1991-1996.

You can reach Richard Toren at (301) 951-5300.