From the November 2016 issue of HealthCare Business News magazine


Launders added: “The big thing driving health care today is obviously the shift to the value-in-care model from the fee-for-service model. This is going to drive some significant changes in how medical equipment is used. Until now, people have been paid to do more procedures. They have done more diagnostic testing in order to get paid in return. The change is that insurance companies and Medicare will be paying on [the] basis of the value of the care, not for the number of individual diagnostic tests and procedures, but one fee to treat that patient.

That is really a fundamental difference in health care finances, and I believe it is going to affect radiography quite considerably. It will keep X-ray around because there is much less cost in providing that service. “The pressures of the new reimbursement policies will ensure prominence of X-ray, in addition to the fact that outcomes are clearer, faster, involve less radiation and are cheaper.”


Tomlinson agrees, saying, “If hospitals are going to be paid for an indication — if someone comes in for an appendicitis episode — and you get paid once for that appendicitis treatment, not for how many X-rays, CTs or MRs you take, the key is not overusing expensive modalities. How will the cost be made appropriate for what the indication is?

If you are going to get paid $5,000 for a case of appendicitis regardless of how you treat it, and you can answer the question with an ultrasound, why would you do an MR? You are spending more for information you don’t need. Once you determine it is appendicitis, you are going to go to surgery. Did you answer it five different ways, with a more expensive test? That is not necessary. In a value-based world there is no reward in using higher-end tests and overusing resources. Even in ED and urgent care, if the patient is footing the bill, they want you to answer the question. They do not want you to overkill the modality.”

Jung shares the view that the new value-based model is “definitely an issue.” CMS is “looking at this and cutting, and imaging [is] always a target for reductions. That very possibly could press things back toward X-ray because CT and MRI can require preauthorization for insurance to approve it," he said. And Silva also acknowledges that “as we see pricing or payments going down, that will put some stress on practice and use of the newest technologies.”

Nevertheless, while these could be factors, Mehta doesn’t think that the new pricing environment will necessarily impact modality usage rates one way or the other: “While X-ray is here to stay, I don’t necessarily agree that it is the automatic test that you are going to give to every patient. For instance, there are so-called Ottawa Rules for ankle injuries that establish that if you don’t meet three criteria, you don’t need to get X-rays. That is widely accepted. As we move forward, we need to be mindful of these binary style algorithms of care where, if it is [a] young patient, positive for X, Y, Z, where the answer may be MR, CT or digital tomosynthesis first. I think that the new guidelines could actually work both ways: they will make sure that we don’t reflexively order either an X-ray or an MRI.”

November 2016 Magazine

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