RSNA Session: Romneycare Holds Lessons for Radiology

The experience of health care providers in Massachusetts — which adopted a universal health care system ahead of the national Affordable Care Act — is valuable to consider when examining how health care reform might impact the role of radiologists in the future, noted speakers at a Monday morning RSNA session. James Rawson, MD, chair of Radiology at Georgia Regent University and the ACR Committee on Governmental and Regulatory Issues in Academic Radiology; Marta Heilbrun, MD, assistant professor in the Department of Radiology at the University of Utah; and Alexander Norbash, MD, professor and chair of Radiology at Boston Medical Center presented "The Changing Role of Radiology in the U.S. Health Care System." Together, they covered why achieving appropriate use of imaging through guidelines and evidence based recommendations is so hard, what the consequences of enacting a universal health care law were for Massachusetts, and finally, how these factors point toward the importance of aligning incentives across the health care system. Dr. Heilbrun spoke first about the barriers to incorporating guidelines and evidence-based recommendations for imaging use. She noted that while almost everyone agrees that evidence-based medicine is the right way to cut down on inappropriate imaging use and prove the value of radiology, actually doing so is "much harder than a soundbite." She noted that there are more than 2,700 guideline summaries in the United States; 53 for diagnostic radiology alone. Many of these guidelines also are complex, and studies have shown that when a multitude of factors must be considered in determining for which patients a test or procedure is suitable, the guideline is frequently ignored. In addition, finding answers to which of various competing guidelines to follow and how to then get those guidelines into actual clinical use is an ongoing challenge. Dr. Norbash then spoke about how health care reform played out in his state, the first to enact universal insurance coverage under Governor Mitt Romney. He noted that Massachusetts was actually fairly close to universal coverage before Romneycare was enacted with broad bi-partisan support. The infrastructure and money were there, and 92 percent of residents already had insurance coverage through existing programs, he said. The enactment of Romneycare reduced the state's number of uninsured residents to 3 percent and lowered costs somewhat. It dropped from the number one state in health care costs to the ninth state in health care costs. However, access to care and cost of care were not addressed in the law, which has not surprisingly led to issues on both these fronts. For Massachusetts radiologists there is a need to integrate care in a very strategic manner, Dr. Norbash noted. "Our challenge is to add value with every single interaction." This gets back to the use of evidence-based guidelines and how to encourage their adoption. A big problem with this nationwide is that although health care reform is progressing, incentives are not aligned across the health care continuum noted Dr. Rawson, who spoke last. "In a world where hospitals are being incentivized to be more efficient, physicians are being incentivized to do more volume," he said. As organizations increasingly consolidate to control costs and achieve efficiencies, consider what behaviors you want to incetivize and how to show the impact of radiologists' work, he advised attendees.

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Additional reporting by Cat Vasko.