AHRA: Is radiology ready? Further cost-cutting reforms on the horizon

ORLANDO, Fla.—Even though the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (PPACA), more reforms will be necessary to control spending and preserve the healthcare system, according to a presentation Aug. 12 at the 40th annual meeting of AHRA: the Association for Medical Imaging Management.

Sarah Mountford, of Physicians Business Network in Overland Park, Kan., explained that annual spending on healthcare in the U.S. had grown to $8,400 per person in 2010, up from $4,800 per person a decade before. Medicare spending is projected to increase at an average annual rate of 6.3 percent from 2013 through 2020.

Radiology is one of the specialties taking the brunt of the blame. “Overutilization is something we are getting creamed for,” said Mountford, who pointed out that the U.S. is number two in MRIs per capita. Japan is number one.

Too often, patients who’ve had an accident and present to the emergency department (ED) undergo a head-to-toe CT whether the symptoms warrant it or not, said Mountford. “It’s defensive medicine and I understand the ED physicians' fears, but [radiology is] taking the hit for that.”

Since 1997, $15.6 billion has been transferred back into the Medicare trust fund through fraud recovery, and Mountford indicated the battle against waste will continue in the future. The PPACA authorized an additional $350 million to fund controls for healthcare fraud and abuse.

Another front in the cost control battle will involve independent diagnostic testing facilities (IDTFs), which operate independent of both an attending or consulting physician’s office and of a hospital. Mountford explained that the Office of the Inspector General (OIG) performed unannounced site visits to 132 Los Angeles-area IDTFs in 2010, and found nearly 35 percent failed to comply with selected Medicare standards. In a similar review in Miami, 27 of 92 IDTFs failed to comply. Now, OIG has recommended that the Centers for Medicare & Medicaid Services conduct further unannounced IDTF site visits.

While reform efforts will include the establishment of health benefit exchanges and new provider models such as the accountable care organization, Mountford said radiology will remain at risk for cuts.

“Until we address the overutilization issue, [radiology is] going to stay on the hit list for reimbursement cuts.”