Keeping Patients at the Forefront
As the health system shifts, radiologists must stay in tune with the needs of their patients.
As I write, open enrollment season is closing and many of our patients are selecting their health insurance plans for 2016. Five years after the signing of the Affordable Care Act, we have seen the number of uninsured Americans drop significantly. There have been, however, concurrent significant changes in the design of health care benefit plans.
Insured patients are paying a larger amount out of their own pockets before their health insurance starts covering the cost of their care. Deductibles average $1,077 and are much higher for many workers, especially those who work for smaller companies that may elect to only offer a high-deductible plan.
I’ve written before about the challenges our patients face when trying to understand the costs of the care they seek and spend their health care dollars as prudently as possible. Recent developments in the health insurance marketplace will make it even more critical for us as radiologists to support our patients as they navigate what is often a complex and confusing landscape of pricing for health care services.
The summer of 2015 saw announcements of consolidation among some of the largest health insurance companies. Aetna announced it would acquire Humana, and Anthem announced it would acquire Cigna. These multibillion-dollar deals will be scrutinized by federal regulators and have drawn criticism from many, including presidential candidates and pundits. Assuming that these two deals pass the sniff test for the Federal Trade Commission and Department of Justice, the number of plan choices for our patients may be more limited and premia may rise. Add to that the failure of many of the health care “co-ops” intended to provide lower-cost options to those seeking individual coverage, and it’s easy to see how patients may have fewer options and tougher choices.
So what can we as radiologists do to help our patients through this? For those subject to higher deductibles and premia, we have a responsibility to make sure that patients are getting the very best value for their health care dollar. This means ensuring that patients receive the right imaging the first time, that our report is actionable, and that our interpretation is meaningful to both our referring physician colleagues and our patients. Is it a challenge to make sure that the right test is ordered when we so often don’t even get adequate history? For sure. Are we smart enough to figure out how to act as our patients’ advocates before they even become our patients? I’m confident that we are.
As we wait for the implementation of clinical decision support in the Medicare program (disappointingly delayed by CMS from the legislatively mandated start date of January 2017), we continue to deal with the delays and lack of transparency imposed by radiology benefit managers. In the meantime, let’s use our ingenuity to ensure that our patients know we are good stewards of both their health and their health care dollars. I wrote in January about the R-SCAN program, which is a way for us to connect with our referring physicians about how to request imaging more collaboratively and effectively. I challenge each of you to participate with your community.
There are many resources available to us to help our patients understand the imaging test they are about to undergo, most notably RadiologyInfo.org. But for some patients, there is no substitute for the ability to ask a doctor. By making ourselves available to answer these questions, we add immeasurably to the value we deliver to our patients. Likewise, being available to answer questions about the report is an invaluable resource for those of our patients who need clarification.
Some of you might ask whether I am living in La La Land. Don’t I understand that you have a huge queue of cases to read and that if you don’t keep your RVUs up you’ll be penalized? I know that for many of us the transition from the productivity-driven Imaging 2.0 world to the land of Imaging 3.0, where the activities I’ve outlined above are valued and rewarded, is progressing more slowly than we’d like. I’m glad to say that we will have more opportunities to include incentives for the types of patient-centered care inherent in the Imaging 3.0 philosophy into the new Merit Based Incentive Payment program that will be part of Medicare in 2019.
From the Chair of the Commission on Economics
By Geraldine B. McGinty, MD, MBA, FACR, Chair