Ising's group, Medical Plaza Imaging Associates, performs about 40,000 procedures a year including CT, MR, nuclear medicine, ultrasound, diagnostic X-ray, and bone density scans. They are located on the campus of Saint Luke's in Kansas City, although they are not part of the health system. It's important to remember that the DRA cuts affect only free-standing imaging facilities and not hospitals. That means if Ising's group were part of Saint Luke's Health System, they would not be subject to the DRA reductions. (Although stay tuned for significant hospital funding cuts proposed as part of the FY '08 federal budget.)

"There are pluses and minuses both ways," Ising said of the mixed blessing of being independent of a hospital system. "One of the things we are looking at is whether the hospital buys out the radiology group and takes it over -- that's a real possibility."


No matter how you look at it, the world of insurance reimbursement -- public and private -- is a Rube Goldberg-style contraption that few fully understand and no one can control completely.

"It's the only industry I'm aware of where the people that are purchasing the goods tell you how much they are going to pay for them," Ising observed. "If I were to go into a grocery store and tell them, well you are charging me $2.50 for that gallon of milk but I think it's reasonable to pay a dollar, they'd call the police. But that's what the insurance companies are telling us."

It's just not reasonable and in many cases not contractual to ask patients to make up the difference in lost reimbursements. If Medicare is paying less, then the patient's portion under Medicare is also less. But private insurers won't pick up the tab. "When you contract with insurance companies, they tell you that you can't charge the patients the difference. You have to write it off and if the patient is part of that insurance plan, you're stuck," Ising explained.

WINDS OF CHANGE
Congress has changed hands. We're moving into a presidential election cycle. The proposed FY '08 federal budget would cut hospital funding significantly and the political advocacy commercials are already running in prime time against it. Will a groundswell of professional organizations and activists focus Congress on the hospital issues and ignore the on-going woes of the independent imaging centers? Or, will the rising tide of interest in health care raise all boats in those waters?

"I would say from talking to folks there is real interest in the moratorium [on the DRA cuts]," Richardson said. "We are getting into a heavy political arena. There is a lot of focus on Medicare and on health care in general so it may garner good support. But if you are going to do some cuts, at least do them in an educated manner so they don't decimate an industry unnecessarily."

"We were hoping [the DRA cuts] would have gotten headed off and someone would have taken a more realistic look at what the cuts were going to do. I don't think anybody had any idea of the magnitude of what would happen if it went into effect," Ising said. "People are going to have to figure out how to do more with a lot less. We've always been fighting the battle to do more with less, but now it's doing a lot more with a lot less."

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