Campaigns to change Medicare are likely to be difficult fights, but Ullrich says this fight must be fought. As just one indication of the irrationality within Medicare's payment decisions, Ullrich points out that the cuts in reimbursement for contiguous body part scans were based on a procedure in an entirely different area of medicine. In part, the new formula was based on the savings Medicare believes are reaped in surgery when two procedures - say, appendectomy and gall bladder removal - are done with one incision.

While radiologists continue to press for changes to Medicare, Ullrich says they also should take on private payers, using the Humana success as their guide.


He points out that, over the course of many months, individual radiology practices raised issues of concern with the company's field representatives. At the same time, the ACR's Managed Care Committee met with Humana's decision-makers, provided them key data, and asked the company's leaders to explain how they arrived at their decision to cut reimbursement.

"Not one of them had any data that justified the adjustment," Ullrich says. A few practices even threatened to sue Humana for breach of contract, he added. Eventually, the managed care giant backed down.

Deciphering the minutia of payment systems, and then trying to convince payers to base their reimbursements on rational factors, can be frustrating, says Ullrich, but the fight is worth it.

"I take it as a challenge," he says. "It's kind of Alice-in-Wonderland, but at the end of the day, it makes a huge difference."

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