The American College of Radiology recently told a House subcommittee and MedPAC that improving health care efficiencies, in regard to imaging, must be approached from the standpoint of quality based on appropriateness of care and physician collaboration, not simply cost cutting.

At a recent House Ways and Means Subcommittee on Health hearing titled "Options to Improve Quality and Efficiency Among Medicare Physicians," Subcommittee Chairman Fortney "Pete" Stark (D-Calif.) said, "As Medicare's steward, Congress needs to ensure that Medicare resources are being used efficiently and effectively to achieve high-quality outcomes."

The ACR took the opportunity to comment for the record on the growth of imaging services, the need for federal standards for physicians who provide imaging, the use of appropriateness criteria when ordering an image, and the necessity of fundamental first steps in wide-scale reform of physician payment.
Representatives from the Government Accountability Office (GAO), the Centers for Medicare and Medicaid Services (CMS), and the Medicare Payment Advisory Commission (MedPAC), as well as several physicians in the private sector testified on the subjects of providing feedback to individual physicians about volume and practice patterns and the possibility of improving efficiency in service delivery by bundling payments to physicians.

Bruce Steinwald, director of health care for the GAO, stated that providing systematic feedback to physicians on their practice patterns is a promising first step toward encouraging program efficiency but said that relying on physician education without financial or other incentives will be suboptimal in garnering greater efficiencies. In addressing the idea of physician feedback, Chairman Stark went as far as to ask CMS Acting Deputy Administrator Herb Kuhn if Medicare can examine utilization rates of individual providers and adjust payment based on individual volumes. Kuhn responded that although CMS can look at volume rates of individual physicians, the act of doing so and providing feedback should initially serve an educational purpose. The Subcommittee's Ranking Member Rep. Dave Camp (R-Mich.) cautioned, however, that in looking at volume rates for various physicians, it is difficult to determine medical necessity by simply looking at claims data.

In his testimony regarding the concept of bundling payments to physicians, MedPAC's Chairman Glenn Hackbarth testified that, "A larger unit of payment puts physicians at greater financial risk for the services provided and thus gives them an incentive to furnish and order services judiciously." He identified areas for bundling services; including services typically provided during the same episode of care for conditions with clear guidelines but with large variations in use of services such as treatment of diabetes.

In its Statement for the Record, the ACR identified its Appropriateness Criteria® as a useful tool for physicians in determining the right test at the right time for the patient. The ACR also registered its concerns with moving toward a system using bundled payments for physicians. The College indicated that questions remain as to how services rendered by a physician in a consulting role, such as is the case with diagnostic radiology, would fit into the concept of bundling. It is the ACR's belief that improving health care efficiencies must be approached from the standpoint of quality with the focus of utilization controls based on appropriateness of care and physician collaboration. Medicare's ultimate goal should be to improve outcomes, rather than simply achieving savings.

To read the ACR's Statement for the Record in its entirety go to
http://www.acr.org/s_acr/doc.asp?CID=3140&DID=26278

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