Becoming Decision Makers

Two radiologists play integral roles in Michigan's Certificate of Need program.becoming decision makers

Regulating health-care cost, quality, and access are the three main objectives of the Michigan Certificate of Need (CON) Commission. But it can be difficult to balance such distinct and sometimes conflicting facets of our health-care system.


On a broad level, the CON Commission's work necessitates teamwork from a variety of individuals. The commission has 11 slotted seats for representatives from hospitals, nursing homes, labor unions, insurance companies, businesses, physicians, and nurses. To see exactly who sits on the commission, visit

Being commission members also requires a unique skill set: the ability to speak intelligently about health care to nonphysicians and the tact to represent the profession while keeping patients' best interests in mind. Using these traits, Michael A. Sandler, MD, FACR, past president of the Michigan State Medical Society and Michigan Radiological Society, administrative physician at Henry Ford Health System, and former CON Commission physician representative, and Suresh K. Mukherji, MD, FACR, professor and chief of head and neck radiology at the University of Michigan, immediate past president of the Michigan Radiological Society, and CON Commission medical school representative, maintain a good deal of influence on health-care policy decisions at the state level.

What is CON?

The CON program was initiated by the federal government in 1974, but beginning in 1986, several states either repealed the legislation or limited its scope. Currently, 36 U.S. states participate in the regulatory program, which was created to ensure that health-care decisions regarding equipment and services keep costs down, optimize access, and guarantee quality. Learn more about the health-planning legislation at

"We want to make sure the cost of health-care services is reasonable and appropriate, but we want to do so with the understanding that we as physicians, especially radiologists, are advocating for the best quality of care for the patient," explains Mukherji. "The commission sets standards and recommends changes to the joint legislative committee of the legislature and the governor, who can accept or reject them, but almost always accepts them."

Four of the 16 covered services for which the commission makes policy recommendations are imaging-related: MRI, CT, PET, and radiation oncology, says Sandler, who ended his nine-year tenure on the commission in April 2012. "It's important to have radiologists on the commission because of our expertise," he says. "We can explain issues and established standards to ensure a degree of quality."

"The standards set a bar for the purchase of imaging equipment, which discourages the proliferation of MRI, CT, and PET units common in other states," explains Sandler. He adds that the CON program is, however, a double-edged sword that also imposes limits on radiologists and hospitals purchasing radiologic equipment. Nonetheless, imagers recognize that the regulations are in place for a reason: to create a better health-care system.

Showing Up

It's clearly beneficial to the specialty to have radiologists involved in making decisions about radiology equipment. Mukherji's commission appointment began after "just showing up." He elaborates, "At our university, we have a team that monitors the work of the CON Commission. The commission reviews the standards and guidelines for each modality on a three-year cycle. Years ago, our institution requested a physician to travel to Lansing, Mich., to hear and monitor deliberations regarding MR and CT. At some point in the process, I gave some testimony. The CON process involves a pretty small community and people quickly recognize if you show interest. One thing led to another and I had the honor of being appointed to the CON Commission for a three-year term in 2011."

As physician and university-physician representatives, Sandler and Mukherji influence policy recommendations. "We make important decisions that affect patients and hospitals," says Sandler. "We're not here to represent radiologists but to give the perspective of a practicing physician. We have to decide what's best for the nearly 10 million people [in Michigan]. I feel quite strongly about that."

Mukherji agrees and points out that since the majority of CON Commission members are nonphysicians, they often turn to the physician members for content expertise. For example, when the group was setting regulations for CT access, Mukherji informed the group that, with newly bundled codes, regulations would already be very tight. He was able to avert an overcorrection of the CT regulations that would have resulted in a severe access problem in the state.

"A lot of people don't really know much about CT, MRI, and PET and how imaging benefits patients on many levels. It helps develop the relationship if you can explain the intricacies of imaging in an unbiased and educational manner," says Mukherji. "In doing so, you develop credibility that helps foster the relationship. The members of the commission include payers, labor representatives, and insurers who are well aware of the unnecessary costs associated with self-referral and overutilization. They agree with radiologists that imaging studies should be performed and interpreted by the most qualified physicians. This is where we have the best opportunity to educate, collaborate, and influence."

Nonetheless, according to Mukherji, there's an even bigger reason radiologists should be involved in the CON process: "We have the opportunity to get involved and participate in the decision-making process. The future of radiology will be much stronger if we help create our future rather than simply adapt."

By Alyssa Martino

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