their insurance benefits, do not take their
medications, fragment their own care by
shopping around for the best pricing, and
participate in lifestyle practices that result
in healthcare costs that could be avoided.
According to a recent study published in
the Journal of the American College of Radiology, approximately 26% to 30% of imaging tests ordered are either unnecessary
or inappropriate. And with the annual
cost of diagnostic imaging now nearly
$100 billion and growing at 17% per year,
unnecessary imaging exams add up to almost $35 billion in wasted costs. 1
So what is the down side? That is always
an interesting question when the federal
government is involved. My first concern
is what I call “madness of confusion.” The
government, through their use of lan-
guage, can make a topic so confusing you
need a law firm to help you understand
how the process works. As you know, in
healthcare, if you do not understand the
reimbursement process, you do not get
paid. There’s also lack of preparedness.
According to Steve Lieberman, president
of Lieberman Consulting, the health in-
dustry tends to operate with a “kind of
herd behavior” rushing to implement
an idea “without working through the
detailed business questions of how they
work.” 3 And then there are hospital merg-
ers and consolidations. ACOs could cause
this ripple effect as hospitals join forces
and purchase physician groups, leaving
fewer independent hospitals and doc-
tors. The end result being greater mar-
ket share, which gives the larger health
systems more leverage in negotiations,
thus driving up healthcare costs. (I am
not sure this is a significant issue as this
practice started before the discussion of
1Gerst S. Accountable care organizations could
dramatically affect radiology practices.
Diagnostic Imaging. December 13, 2010.
Available at: http://www.diagnosticimag-
Accessed May 20, 2011.
2Accountable Care Organizations: Improv-
ing Care Coordination for People with
Medicare. Healthcare.gov. March 31, 2011.
Available at: http://www.Healthcare.gov/
e03312011a.html. Accessed May 20, 2011.
Jim Lipcamon is the outpatient imaging services
manager at East Cooper Medical Center in Mt.
Pleasant, SC and is editor-in-chief of Radiology
Management. He holds a bachelor of science degree
in healthcare management from Bellevue University.
Jim may be reached at James.Li pcamon@tenethealth.