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Reflections From a Moorefield Fellow
My introduction to the economic aspects of healthcare began early in medical school. While I had no previous economics or business experience (I was a history major during college), I was quite fortunate that Baylor College of Medicine offered a business and medicine elective during my first year. I will admit that, initially, a large draw was the generous amount of peanut butter and jelly sandwiches provided during each class. However, our professor proved to be an extremely engaging speaker, with his experience as an insurance executive allowing him to provide a truly unique perspective on the intersection of business and medicine. I still remember how he remarked that in the financial world, doctors are known for their “high income, no business sense.”
That lack of business sense proved all too true for myself — which even that class could only begin to remedy. However, it did spur me to continue learning more about the economic and health policy aspects of medicine — a process that continued in fits and spurts through medical school and into residency. Indeed, in this era of rapid change and consolidation within the practice of radiology — where it seems as if we will all end up as employees of one corporate behemoth or another — I felt I could no longer remain ignorant about how such a fundamental aspect of our specialty functions. Thus, when the opportunity arose, I applied for and was extremely fortunate to receive the James M. Moorefield, MD, Fellowship in Economics and Health Policy.
Jointly sponsored by the ACR and the Texas Radiological Society, this fellowship provided an opportunity for me to spend two weeks with the ACR’s economics and health policy department at its headquarters in Reston, Va. Though I was only there for two short weeks, I learned an incredible amount about the economic fundamentals underpinning the practice of radiology and the often overlooked, behind-the-scenes activities of the college’s economics team. Although I am still far from an expert, this brief experience has vastly increased my appreciation of the complex business landscape facing all of us today and the efforts of the ACR to advocate on our behalf.
During those two weeks, individuals from each of the Commission on Economics’ subcommittees took time out of their busy schedules to meet one-on-one with me to explain the intricacies of their work and allow me to assist with their various projects. Even ACR CEO William T. Thorwarth Jr., MD, FACR, found time to meet with me to discuss the long history of radiology leadership in national healthcare economic policy and his vision for the future of our specialty. I saw firsthand the process of proposing new Current Procedure Terminology codes, listened to conference calls discussing strategies for assigning appropriate relative values at the AMA/Specialty Society RVS Update Committee, learned words like “cross walk,” helped answer billing and coding questions submitted by ACR members, and even helped draft some of the technical language for an update to the lumbar puncture terminology.
I also learned just how keen the challenges are that radiology faces in an everchanging economic landscape. At the public hearing for the second of the Medicare Payment Advisory Commission’s two annual reports to Congress, I saw how radiology was called out as a driver of high healthcare spending. I learned about the difficulty in funding widespread lung cancer screening, despite strong evidence for its efficacy and the ever-present pressure from insurance companies to reduce reimbursements. Most importantly, I saw the dedication and vastly underappreciated efforts of the economics team in advocating for our interests and reduce what could have been a 20 percent cut in reimbursement to only 5 percent.
I had an amazing experience with the economics and health policy department and sincerely thank the ACR and TRS for this incredible opportunity. Despite everything that I have learned, there is still so much more for me to understand. I hope that we can all learn just a little bit more about the economic and business aspects of our specialty, because in a complex healthcare environment where change is often imposed on us from outside, it’s certainly better to be at the table than on it.
By Zachary S. Jeng, MD, diagnostic radiology resident at Baylor College of Medicine in Houston