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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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Galen Hiveley

Replacing equipment

November 12, 2012 10:01

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.

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S. Flemming

Focus on the Real Root Issue - Imaging Costs are the problem

November 08, 2012 03:29

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_compared_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-cost-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-costs-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?

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Gary Provenzano

Re: Focus on the Real Root Issue - Imaging Costs are the problem

November 11, 2012 11:01

Most outpatient imaging centers are getting $400-500 per mri study from insurance companyies. Medicare reimbursment is..what? $320? Absurdly Low...

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S. Flemming

Re: Focus on the Real Root Issue - Imaging Costs are the proble

November 11, 2012 05:17

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.

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S. Flemming

Re: Focus on the Real Root Issue - Imaging Costs are the proble

November 11, 2012 05:17

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

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Gary Provenzano

Fix the root problem

November 08, 2012 03:29

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.

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S. Flemming

Re: Fix the root problem

November 09, 2012 01:28

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.

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Brian Tunell

Liability

November 19, 2012 12:56

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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John McGough

RE:

November 09, 2012 05:00

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.

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S. Flemming

Re:

November 09, 2012 05:33

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......

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John McGough

Re:

November 09, 2012 06:45

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.

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