Road Map for Reform

Topics: Imaging, Service Lines, Health Care Reform, Market Trends, Strategy, Volume Growth

By reading this white paper, members will understand:

• The four reform provisions most likely to impact radiology
• The anticipated impact of the provisions on radiology volumes and reimbursement
• Key lessons in preparing the department for an accountable care environment
• The changing role radiologists must play in their market under new reimbursement models

Download Road Map for Reform

Executive Summary

An industry in transition

The Patient Protection and Affordable Care Act (PPACA) is shaping up to be one of the most transformative pieces of health care legislation in decades. Coverage expansion remains a point of contention and bears some risk of legal challenge as the Supreme Court reviews the bill. Efforts to establish new payment models, however, enjoy broad bipartisan support, at least in principle, and offer the greatest opportunity to redefine the nation’s health care landscape.

Evaluating the impact of reform

Health care reform presents a multitude of challenges to be identified and addressed, yet four initiatives in the PPACA present the greatest potential to impact the imaging business:

• Coverage expansion
• Value-based purchasing
• Bundled payments
• Shared savings

Coverage expansion is likely to have a somewhat positive impact on imaging departments, primarily through the alleviation of bad debt from previous uninsured patients, but will not provide a dramatic boost to imaging finances. Of the new payment models, proposed incentive structures make imaging a poor target for reduced utilization. Despite this fact, imaging leaders must understand each program in detail to protect the department from inappropriate utilization reductions.

Preparing for the accountable care challenge

The transition to accountable care will be defined by a shift in hospital reimbursement from the traditional fee-for-service approach to one rewarding quality and efficiency. This drastic realignment of incentives will require imaging leaders to reimagine their department’s role in the larger organization, focusing less on generating profitable volumes and more on leveraging imaging as a mechanism to limit length of stay and trim total cost of care.

Imaging leaders must also serve as advocates for the department during the transition, preventing any excessive utilization management efforts that may damage the organization’s profitability and jeopardize patient care.

Reimagining the role of radiologists

Radiologists will also find that their place in the accountable care environment differs considerably from their traditional role. Given current incentive structures, both hospitals and radiologists benefit from maximizing the volume of scans performed.

As the industry transitions to payment models that reward cost-effective care, radiologists will need to dedicate an increasing portion of their time to educating referring physicians on appropriateness, instilling effective ordering guidelines, and identifying potential areas for improving efficiency in department operations. Radiologists may also seek to participate in the risk-sharing components of accountable care organizations, but will likely need to proactively pursue previously uncommon alignment approaches to do so.

Members, learn more

Imaging Performance Partnership members can download the full study below.