What to watch in 2012 across service lines
Topics: Service Lines
January 25, 2012
In the second in a series of articles, we explore the issues to watch in 2012 across cardiovascular, imaging, orthopedics/neurosciences, surgery, oncology, and women’s service lines.
Cardiovascular
Future device rollout and CMS payments for transcatheter aortic valves
Despite the excitement surrounding the recent approval of the first US transcatheter aortic valve, Edwards LifeSciences’ SAPIEN, cardiovascular executives should carefully weigh the procedure’s complexity and high costs prior to adopting the technology. The FDA and professional societies stress the role of multidisciplinary care, incorporating the expertise of myriad specialists, and careful patient selection for successful program implementation. Moreover, the existing economic outlook is unfavorable, and it remains to be seen if CMS will make adjustments to reimbursement for these new procedures.
Imaging
Medicare’s reimbursement changes
2012 is shaping up to be an uncertain year for radiology. For 2012, Medicare will expand the Multiple Procedure Payment Reduction to the professional component of advanced imaging exams and will continue to implement reductions in professional and technical reimbursement for most advanced imaging services. For hospital radiology departments, the 2012 Hospital Prospective Payment System Final Rule provides some welcome relief alongside some unexpectedly significant cuts.
Where to learn more: Imaging Performance Partnership members may explore the details of the upcoming changes to imaging reimbursement and our guidance on navigating these modifications by reading Imaging Payment Update for 2012.
Orthopedics/Neurosciences
Demonstrating the value of spine surgeries through measurable and comparable outcomes
Across 2012, the fast-rising cost of spine surgery will get special attention. Private payers will continue to push back on these elective, discretionary, and incredibly expensive interventions. Accordingly, hospitals and physicians will need to work together to ensure appropriate utilization and to start demonstrating the value of spine surgeries through measurable and comparable outcomes.
Surgery
Managing role of robotics, setting of care shifts in surgery
Continued growth in new robotic surgery platform investments has had a substantial impact on hospitals’ surgery department strategy. Though lower length of stay and potential reduction in rates of complications can bear clinical and operational advantages, the incremental costs incurred within robotic procedures can negatively affect per-procedure and overall profitability. In 2012, institutions will continue to face greater opportunity to convert cases to the outpatient setting through use of advanced technology, and greater pressure from payers to do so.
Oncology
Continued Focus on Determining Appropriate Role of Screening, Advanced Treatments in Cancer Care
In line with the broader focus on controlling utilization and cost of health care services, cancer care will continue to fall subject to debates over appropriate utilization of services. Recent studies scrutinizing the role of mammography and PSA screening tests for breast and prostate cancer, respectively, have stirred contention between patients, providers, and insurers. The increasingly aggressive use of advanced treatments—namely advanced radiation therapy and robotic surgery—will continue to spur efforts to reconcile appropriate use of new treatments with the goals of evidence-based medicine and cost-effective care.
Women’s
The impact of digital breast tomosynthesis
The long-awaited arrival of digital breast tomosynthesis has not been met with the immediate adoption some may have expected given its highly-touted clinical benefit. Instead, a higher price tag and lack of incremental reimbursement have left many breast center administrators in a “wait-and-see” mode. With new breast imaging technologies set to be unveiled across 2012 and increasing confusion around screening mammography guidelines, administrators will need to consider quickly if tomosynthesis is the right technology for them.
Stay tuned for the next installment of our series. Or catch up by reading our predictions for the 2012 Workforce.
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