RBMA Bulletin

Radiology Business Management Association - The RBMA Bulletin contains featured articles on radiology business issues, association news and events

Healthcare Excellence Despite Lower Reimbursements

Bridging the Gap and Meeting Demands

Healthcare reform ups the ante in terms of expectations, attempting to measure (and pay) in a world of quality, where patients are “cured” the first time around and the effectiveness of their physicians determined by whether they accomplish that goal. Value-based compensation models, while still functionally vague, are the intended mandate and represent a quantum change from current fee-for-service models.

bridging the gap in healthcare illustrationThe “new” model of healthcare comes on the heels of recent reimbursement cuts, the implementation of “5010” (the new format for standard electronic Health Insurance Portability and Accountability Act transactions), the threat of penalty for failure to submit quality data codes compliant with Physician Quality Reporting System (PQRS) measures to the Centers for Medicare and Medicaid (CMS), confusion regarding changing Meaningful Use requirements, an often hostile environment of Recovery Audit Contractor (RAC) audits and even more confusion over how to function with future payment systems. In our new world, the quality of healthcare will improve based on objective measurement and the “value” of the patient experience, all at lower cost for those paying the bill.

Better healthcare for less cost? The demand for more service, higher standards of accountability (while at the same time simplifying administration), and increased levels of compliance reporting usually go hand in hand with higher costs. Practices are rapidly facing the need to upgrade technology and personnel skills, with perhaps a greater reliance on support from consultants and professional organizations to help them navigate the waters.

This type of contradictory, disruptive messaging tips the balance of certainty and stability, puts us on high alert, and allows for fear, uncertainty, and doubt to set in. Some of the credible surveys conducted in 2011/2012 show physician morale at an all-time low, with many providers considering the safety of employment over practice ownership and others even considering a change in career.While this should come as no surprise given an increasingly hostile business environment, it would be unfortunate and further add to the predicted physician shortage in the future. In fact, solutions to this crisis are actually within reach.

Radiology is usually viewed as a “behind the scenes” specialty, where contribution to the patient’s circle of care is consultative and supports those physicians with direct patient contact. While radiologists could in theory support the concept of “value” in medicine, they in fact have little control over how their interpretations are used to drive improved outcomes. At the same time, as quality becomes the watchword, insurance companies in some parts of the country are attempting to steer patients to lower cost providers without consideration of quality. How does radiology move then from the perception of being a “passive” specialty in regard to patients, potentially treated as a low-cost commodity and therefore, able to maintain some level of control over its destiny?

Alan C.Kay stated, “The best way to predict the future is to create it.” What can this look like for radiology?


The Future Dictates the Present

Future Puzzle of HealthcareLess than a decade ago, technology promised to form the future. In today's rapidly changing, collaborative setting, the future dictates today's technology.

Technology of the present must be built to anticipate and accommodate changes of the future. Regardless of how the version of standards regulating the electronic handling of health care transactions change, systems must possess the characteristics, foundation, and structural underpinning necessary to allow for tweaks in a day-to-day environment as well as leaps for future requirements.

This means the technology company's organizational infrastructure has to be in lockstep with the practice plans, while both are anticipating and overall industry future trends. Your technology vendors should be able to articulate where they see the industry going and how their research and development (R&D) investment is ensuring they will be leaders in the game not only next year, but five and ten years from now. For example, a decade ago we focused on the cost and complexity of interfaces and each time a new hospital was added to the billing system, it could involve a fairly substantial amount of time and money. Groups would often interface only to the largest hospital served and work smaller entities from paper. As time went on and interfaces became standardized (and cheaper), it became practical to add even relatively small sites via electronic interface. So what did we focus on instead? Further automating traditionally manual billing process—from charge reconciliation to claims submission to coding to claims follow-up. Obviously this means your partners in technology should be a vital part of practice initiatives to maximize employee productivity and reduce costs.