So why care about what one state
is doing? It’s important because Massachusetts is serving as a litmus test
to the rest of the country about what
happens when you implement significant reforms. For starters, there’s the
fact that insuring people isn’t enough,
you also have to figure out a way to
pay for it. And when you put providers
and payers on a budget, questions and
answers about value become critical.
While federal lawmakers face another
tough year of budget issues, including
averting the “fiscal cliff,” sequestration,
Medicare payment cuts to physicians,
and tax increases, the list of “pay-fors”
will start to grow. High ticket items will
make their way to the top of the list,
including imaging. Cuts to imaging payments to offset deficits have been on the
table since 2006 when Congress capped
non-hospital technical component payments to hospital outpatient payments
under the Deficit Reduction Act (DRA).
Since then, we’ve seen accreditation
requirements, changes to the Medicare
physician payment formula, and other
policies enacted designed to decrease
utilization and spend in the non-hospital
What This Might Mean
As federal and state governments continue to grapple with a combination of
declining budgets and increased demand
for healthcare, and fee-for-service payment systems shift to value based and
other risk sharing models, there will be
substantial implications for providers.
Meeting the demand for quality outcomes,
supported by the integration of care delivery, will need to be met within the context
of greater healthcare cost constraints.
Radiology leaders should play a key
role in multi-disciplinary and multi-
specialty teams, bringing to the table a
better understanding of financial risk
and management when it comes to imag-
ing. Importantly, radiologists can serve
as the gatekeepers to ensure that the type
and amount of imaging tests ordered are
clinically appropriate. Decision support
tools, increased evidence based standard-
ization of care, and partnerships with
companies to develop new technologies
that improve outcomes and reduce costs
are some of the tools that can ensure that
radiology is an integral part of a solution
to the complex and challenging issues
facing healthcare today.
1Cigna. Accountable Care Organizations
(ACOs). 2012. Available at: http://
ACO. Accessed December 18, 2012.
2Becker’s Hospital Review Staff. “The 12
‘Biggest’ Hospital Stories of 2012.” ASC
Communications. November 11, 2012.
Available at: http://www.beckershospital
December 18, 2012.
3Alliance for Health Reform. The Ultimate
State Medicaid Calculation: RWJF’s
Lumpkin on the Implications. Available at:
asp?vid= 30. Accessed December 18, 2012.
4Legislative Briefing. “Chapter 224 of the
Acts of 2012: The Future of Health Care
Cost Containment in Massachusetts.”
October 1, 2012.
Laurel Sweeney is Sr. Director, Health Economics &
Reimbursement at Philips Healthcare. She can be
contacted at firstname.lastname@example.org.