Imaging is facing ever-closer scrutiny on reimbursement
and utilization. Is a new role for radiologists in the making?
By Gary Baldwin
When Bibb Allen, M.D., surveys the imag- ing landscape, he sees a pockmarked fis- cal terrain. Currently serving as vice chair of the American College of Radiology’s Board of Chancellors, the 21-year industry
veteran says a combination of factors is putting unprecedented economic pressure on imaging.
The Centers for Medicare and Medicaid Services has been cutting
reimbursement for radiology services since the Deficit Reduction Act
in 2006, he says, with reimbursements for some studies declining by
50 percent since the act and six subsequent CMS cuts.
Add to that declining volume—the Medical Imaging and Technology Alliance estimates that studies were down 3 percent in 2010
among Medicare recipients, and a utilization study by the Health Care
Cost Institute found a 5. 6 percent decrease in radiology services utilization for private insurers in 2010.
Those declines are in part due to the recession, in part to the rise
of non-invasive surgical procedures which no longer require as much
imaging, Allen says. Regardless of the cause, you have the elements
of fiscal uncertainty. “There is full employment in radiology,” he acknowledges. “The American College of Radiology data show the same
number of people retiring as graduating. But the idea of getting five job
offers in your hometown after residency is not happening anymore.
Radiologists cannot be picky about where they work.” Not only that, Allen says that in the rapidly emerging quality and outcomes-conscious
era of accountable care, radiologists will have to assume a new role—
one wrapped around assuring appropriate utilization, rather than just
churning out reports at the behest of referring physicians.
The changes are reverberating throughout the imaging industry,
experts say. Many radiologists say they feel like they’re in the cross-
hairs of payers, which often see imaging as an expensive line item
that’s prone to over-utilization. In addition, the rise of accountable
care organizations also puts radiologists in a tenuous financial posi-
tion as they struggle to gain at a voice at the table when it comes to
administering new ACO reimbursement models such as bundled
“Imaging is under intense scrutiny and there is a high degree of pres-
sure from the cost and quality perspective,” says Rita Numerof, a St.
Louis-based consultant who advises payers, hospitals and device
manufacturers. “The general belief is that there are too many proce-
dures, and a lot of these are surgical. And whenever you have surgery,
you have imaging.” Payers, she contends, believe that “too much im-
aging is being done that is not medically necessary.” Wrap that around
concerns over radiation exposure (see cover story, page 20), and the
challenges to imaging medical necessity will only grow—particularly
as patients increasingly foot a larger share of the bill. “We are just see-
ing the tip of the iceberg,” Numerof says. “The consumer will be less
inclined to get an MRI or CT.”
Payment reductions in the fee-for-service world are already hav-
ing an impact on imaging practices. “Imaging is in the line of fire be-
cause it is easy for CMS to tackle,” says Chad Wiggins, CEO of Radiol-
ogy Associates of Northern Kentucky, a 32-physician group practice
based in Crestview Hills that performs some 600,000 annual studies
on behalf of eight hospitals that comprise St. Elizabeth Health Care
and one smaller, stand-alone community hospital. The group offers