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Dr. Frank Lexa

What does Obama's re-election mean for imaging?

by Loren Bonner , DOTmed News Online Editor
President Obama's re-election, coupled with strong Democratic support in Congress, has health care reform on a path forward toward full implementation by 2014.

In the October issue of the Journal of the American College of Radiology, Dr. Frank Lexa, a professor in the department of radiologic sciences at Drexel University in Philadelphia, argued that the results of the presidential election and health care reform's fate will have a significant impact on the future practice of radiology.

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"If it follows the path of state-level reforms in Massachusetts, on which PPACA was modeled, radiologists should expect health care costs to continue to rise, prompting a push for increased revenues and alternative models of reimbursement not based on fee-for-service," Lexa said in the article.

In other words, lower reimbursement and more federal control over the use of advanced imaging in clinical practice.

I caught up with Lexa and asked him to explain what he means in more detail. Here's an edited version of our conversation.

LB: Overall, what does Obama's re-election and the continuation of the implementation of health care reform mean for the future of radiology?

FL: The biggest news from the election for me is if you look where we'll be on Jan. 20, 2013, it will look like what things have looked like over the last two years. We'll have the same president, a Senate controlled by Democrats and a House controlled by Republicans, which is where we are now. You can expect a continued attempt from the White House to stay on the path and follow the trajectory in the health care bill. The president has said all along — going back to the time before the Supreme Court's decision — that he's very determined to do this [health reform] and he's not going to give up. He made a comment that if the Supreme Court had knocked it down, he would just start over again. Of course with an opposition in the House, they will do what they can to try to modify the implementation of the bill, but with a president that doesn't have to get elected again, I would suspect that he'll want this to be his signature piece for what his legacy will be. I don't see him giving up on it the way other presidents have. He's going to try to implement the plan along the lines he talked about. You have a status quo basically.

LB: What does this mean for radiologists?

FL: Certainly the bill has not been kind to us, and the ethos in the bill is very much a transfer of power from practitioners to hospital entities but also from specialists to primary care doctors. That's not a secret. It's clearly in the bill — putting more money in the hands of primary care. Certainly one of the worries I would have for the future of U.S. medicine is whether or not we are going to hurt some of the things we do best, which is cancer care, care for premature babies and trauma victims and things that require high-level care and multi-specialty facilities. And that's work we're respected for around the world.

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Fix the root problem
by Gary Provenzano on November 08, 2012
I've got an idea! Have the government stop borrowing money from a
privately and foreign owned bank, called the "Federal" Reserve,
which is causing the inflation on any meaningful service or
commodity.
Then bring the jobs back that bring tax revenue, and insured
patients.
This is systemic, deeper than just healthcare.


Re: Fix the root problem
by S. Flemming on November 09, 2012
In response to: Gary Provenzano
Agreed Gary.
However, I don't think the reason our Healthcare costs are where
they are at because of inflation or the current foreign debt
crisis. This has been a much longer story than that....
You are correct in that the problem is deep and systemic, but
with regards to the US healthcare scenario it's a uniquely US
problem, primarily caused by years of greed driven actions that
were designed to maximize dollars with little regard to human
life. The same medical equipment/pharmaceuticals are sold by the
very same companies at massively inflated prices in the US
compared to other countries. And if these products indeed cost
that much, then it would make it nonviable for them to be sold in
other developed countries for a fraction of their cost here.
Companies don't sell products at a loss....the problem in the US
is pure greed and corruption, adding numerous layers of
unnecessary flab in the middle so that many palms are 'greased'
along the way, ultimately making most things unaffordable to many
who need access to them.
If only we could enforce every American to watch the Michael
Moore documentary 'Sicko', then perhaps we would see people
rising to action....but the media keeps most of us dumb.


Focus on the Real Root Issue - Imaging Costs are the problem
by S. Flemming on November 08, 2012
An interesting article, and like many things that are read on the
internet, only gives the partial story. Sadly, like many of our
voters, they don't bother to dig a level or two deeper, instead
taking the message at face value and solidifying their belief.
And our media system has done a wonderful job at brainwashing
most of us.
The root of this 'potential' imaging problem is not the
administration, it's not the plans for universal health care,
it's not even the manufacturers of the imaging devices!
The problem exists simply with years of compounded greed and
corruption, bloating our healthcare system into this gluttonous,
inefficient monster.
The USA has the most expensive health care system on planet
earth, and ranks DEAD LAST in quality of care against every other
developed country - even some south american countries offer
better quality of care for a tiny fraction of the price. Yet the
media loves to spout stories of how these other countries have
horrendous waiting lines and terrible care. I've lived in Europe
and Australia, using public healthcare systems that frankly put
even the most expensive US medical establishments to shame - I
worked for the world's leading software company and had the best
healthcare insurance in the country, didn't pay a dime for
anything. Don't believe the propaganda:

http://campusprogress.org/articles/u.s._health_care_ranks_last_co
mpared_to_other_countries/

To further elaborate before I conclude on the imaging question.
Consider something as simple a procedure as an appendectomy, it
can cost from the cost of a fridge to the cost of a house. Same
procedure, but can differ by tens/hundreds of thousands. Average
cost is $33,000.00 in the USA - average people without adequate
insurance would lose everything for one of the most basic and
routine surgeries! Their house - GONE. Their kids chance of
attending college - GONE. They could spend their lives digging
themselves out of debt, most likely going bankrupt. Or they could
hop over to Canada (say you are on vacation) without insurance
and have it done for less than $2000.00 by the best of surgeons -
madness!

http://www.tampabay.com/incoming/how-much-does-an-appendectomy-co
st-study-says-price-can-range-from-1500-to/1226863

In conclusion, this article on imaging is just another example of
why we NEED HEALTHCARE REFORM, we need the government to step in
and offer healthcare options that are affordable and available
for everyone, and over time will inevitably cause the intrinsic
greed of the healthcare/insurance establishment to HAVE TO CUT
THE FAT and be COMPETITIVE. Imaging is not the problem, it's the
greed and corruption in the middle that drives the cost up to
astronomical levels.
Another recent example specifically on imaging, shows that you
can have an MRI in France for $280, but in the US you will pay
upwards of $1080 (I've seen charges on my insurance bill far
higher, again supporting the great variance in pricing across the
USA).

http://www.washingtonpost.com/blogs/ezra-klein/post/why-an-mri-co
sts-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.
html

The original poster of this article is simply worried about his
job,and I understand where he is coming from. Given the crazy
costs for almost every single medical procedure in this country,
public (Obama-Care) healthcare options may initially be unable to
offer higher cost things such as imaging scans. But, the scans
shouldn't cost so much, and that's really the root problem. Until
insurance companies and the medical establishment are slowly
forced to be competitive and stop their insane greed, it's true
that some people may not have access to imaging. 
But let's be truly real here. If you already have good health
insurance, you don't have to worry - imaging is covered. If you
don't have health insurance, you may not be able to get necessary
imaging, but this is not because of Obama-care or health reform.
Please understand that it's the very same
companies/establishments that paid governor Romney millions of
dollars to try and win this election that are stopping you from
gaining access to these scans. They want to continue charging 10
to 100 times more for procedures than every other developed
country where people have easy, available and affordable  access
to the necessary care to keep them healthy, in some cases alive.
These companies/establishments don't want to change, they like
their multi-billion dollar profits and who can blame them? It's
been a great ride - let's not worry about that 47% of Americans
as governor Romney put it. Let them suffer, who cares.
But this can't continue, if only for the sake of creating a
system where ANY sick person can receive help, and not literally
lose the shirt off his/her back in the process.
Healthcare reform is an absolute necessity in this country and
the only people against it are those who currently profit from
it's current state - those in the
insurance/medical/pharmaceutical establishments, and those who
don't want to pay any more taxes to help support the very people
who made them wealthy in the first place.
I'll leave you with a thought from the wonderful philanthropist
Bill Gates. He realized that his amazing wealth as the world's
wealthiest, flowed from the people of the world, without them
buying his products, he would have nothing. So it's only right
that some of that money should flow back to help the world that
provided it. IN fact, he is flowing back over $40 billion dollars
of his own money, almost his entire fortune.

So, is the real problem Obama-Care?


Re: Focus on the Real Root Issue - Imaging Costs are the problem
by Gary Provenzano on November 11, 2012
In response to: S. Flemming
Most outpatient imaging centers are getting $400-500 per mri
study from insurance companyies. Medicare reimbursment is..what?
$320? Absurdly Low...


Re: Focus on the Real Root Issue - Imaging Costs are the proble
by S. Flemming on November 11, 2012
In response to: Gary Provenzano
Oh...and $500 is absurdly low?
Yet in France you can have an MRI for $280 if you walk in off the
street. And France is hardly a poverty stricken country....doing
much better than the almost third world poverty that pervades
many areas of this so called wealthiest country in the world! But
the wealth is in the hands of the few.
Another fact - there are 100 individuals in the USA who have more
money combined than 50% of the entire population. Think about
that. 100 people who have (and keep to themselves) more money
than the combined incomes of over 150 MILLION Americans.
Job creators right? LOL


Re: Focus on the Real Root Issue - Imaging Costs are the proble
by S. Flemming on November 11, 2012
In response to: Gary Provenzano
Perhaps this is true.....yet if you don't have insurance then you
pay $1100-$1500 out of pocket. A point raised by another poster.
The system is entirely corrupt, the insurance companies charging
families almost as much as their mortgage payments each month for
comprehensive insurance coverage, yet they don't pay the hospital
anything like the amount they would charge an individual. That's
just wrong, the price should be the same. Insurance companies
manipulate the system to screw people (many of whom struggle to
afford to cover their families) when they don't need to. All
about the money.
I recall reading an interesting article a few year back about how
the Chinese government went to the companies who make MRI
machines and basically said, we don't like the price you charge.
Of course it was met with great resistance and sob stories of how
much R&D it had taken to build these machines being the driving
factor behind cost. The Chinese government stood their ground and
put out to tender, the most competitive company winning country
wide contracts for doing MRI's. The end result? A Chinese
national can walk in for an MRI for $75.00 And you know these
companies are still making a profit. But politicians here are so
controlled by these types of companies because they rely on them
for financial funding, they are there monkeys, and until that
changes, let's keep a big supply of bananas.


RE:
by John McGough on November 09, 2012
Also I would think that a big problem is that insurance companies
can pay half the price if you have insurance.  Example.  CXR:  A
given person's insurance company has a negotiated payment of $90.
 Another person who doesn't have an insurance company that
negotiated that price has to pay $210 for the same service.  This
is totally bogus.  The cost should remain static from person to
person.  Same with bank loans.	Interest should remain static. 
If the bank feels the risk is too large, simply don't give the
loan.  The loanee will be much better off without paying a
600$/month bill on something someone who makes decent money would
pay 400$/month.  Charging interest rates that you know they can't
afford will not make them more apt to pay up and does NOT reduce
the risk taken in giving the loan.  Just makes the honest poor
people pay the way for the dishonest ones.  When it all boils
down the bottom line is, stealing should be illegal.


Re:
by S. Flemming on November 09, 2012
In response to: John McGough
Whenever you want to understand the driving factor behind almost
everything in life, the deeper you dig, you will inevitably find
the dollar bill at the root of it all.
When in doubt, look for the money......

I remember seeing an itemized hospital bill for a short stay I
had - one 500ml bottle of no-name water was $47.00
And yet the insurance companies will say that it's dishonest
members driving up the costs for everyone! Don't make me
laugh......


Re:
by John McGough on November 09, 2012
In response to: S. Flemming
and by dihonest members they mean people that have already been
taken bankrupt by rediculous bills and interest rates.	You're
right.	Follow the money.  The money is kept in the bank.  Also
funny how alot of banks also supply several different types of
insurance.


Replacing equipment
by Galen Hiveley on November 12, 2012
And, starting in 2013, Medical device manufacturers will have to
pay a 2.3% tax on sales of equipment. That cost will get passed
directly on to the end user. Brilliant! 

Also, currently, Section 179 of the Internal Revenue Code allows
taxpayers to deduct up to $139,000 of depreciation on qualifying
new and used assets placed into service during the 2011 tax year.
Starting in 2013, the current legislation has reduced the
deduction to $25,000. Seems to me our government doesn't want the
sales of equipment in the Health Care Market. Equipment sales
will no doubt really drop off starting in 2012 and more layoffs
will happen in the Health Care Equipment industry.


Liability
by Brian Tunell on November 19, 2012
I work for a healthcare system, and almost everything I've
experienced has been because of Liability. If tort reform were
invoked, I would expect to see healthcare costs drop.

All you have to do is sit in front of a tv, and every other
commercial is for a law firm trying to attract customers who MAY
have had, or MAY know, someone who was affected by this or that.

I haven't heard of any part of Obamacare that deals with this.
Probably because it's all about turning healthcare over to the
government - which is inefficient and unable to balance a budget
in it's own right.

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