More on how healthcare reform will affect providers

As part of the passage of the healthcare reform legislation last week, various healthcare provisions, several of them imaging related, were enacted as part of the legislative process that will affect the management of routine clinical practice.

Included in the newly passed healthcare bills is the Physician Payments Sunshine Act (S. 301), a policy introduced by Sens. Herb Kohl, D-Wis., and Charles Grassley, R-Iowa, which requires disclosure of gifts and payments given to doctors from the pharmaceutical, biologic and medical device industries. For two years, Grassley and Kohl, as ranking members of the Finance Committee, have been investigating the nature of financial relationships between doctors and industry.

Under the Sunshine Act, this patient disclosure provision will require self-referring physicians to inform their patients in writing that the physician/facility will benefit financially from the imaging procedure. The law also will require the physician/facility to provide a list of additional imaging facilities from which the patient may receive their imaging services.

The American College of Radiology (ACR) said that though it is frustrated by Congress’ continued “unwillingness to tackle this issue by closing the in-office ancillary services loophole, the college is pleased that Congress has taken a first, albeit small, step to confront this growing problem.” The ACR said it will continue to work with Congress to demonstrate the need for stricter self-referral guidelines.

Also rolled into reform legislation is the Medicare Payment Improvement Act of 2009 (S.1249), a bill that seeks to reform the Medicare physician reimbursement so that it rewards healthcare providers based on the quality of care they provide. Under this proposal, according to Kohl, states that achieve higher quality-to-cost ratios will receive an increased reimbursement from Medicare. He said the proposal will help address the problem of geographic variations and reward high-quality providers.

The new law also creates a Center for Medicare and Medicaid Innovation (CMI), which will explore various models to address poor clinical outcomes or potentially avoidable expenditures. One of the models specifically suggested in the statute for CMI involves linking payments to physicians who order advanced diagnostic imaging services to their adherence to and use of appropriateness criteria for the ordering of such services, according to the ACR.

Finally, several provisions to protect policyholders, business, and taxpayers from healthcare fraud and abuse, including new tools for the Department of Justice prosecutors, stronger protections from fraud for small businesses that offer employee health insurance coverage and improved methods for identifying and preventing fraud involving Medicare, Medicaid and private health plans.