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Health Care Tour: “Seeking Patient-Centered Care”
Greenville Radiology, PA
The Issue:
- Medical imaging has transformed health care with high-technology and high-priced procedures. Radiologists at Greenville Radiology provide imagery analysis for the physicians providing care.
Findings:
- Greenville Radiology, Professional Association (GRPA) consists of 41 board-certified radiologists who perform a variety of procedures including mammograms, ultrasounds, X-rays, MRIs and CT Scans.
- The hardware includes:
- MRIs (Magnetic Resonance Imaging) use radio waves to produce images.
- MRIs produce great anatomical detail and are better for certain modalities. Example - The gallstone detection rate with an MRI is nearly 100% vs. only 10 % with an X-ray.
- CAT or CT Scans (Computerized Axial Tomography or Computed Tomography) use ionized radiation to produce images.
- CT scans are faster than an MRI and can scan the brain in 15 seconds vs. 20 minutes using an MRI.
- A few years ago a 4-slice scanner was the standard. Now there are 16, 32, 64, 128 and 256-slice scanners. Today’s scanners are fast enough to image a beating heart.
- Cost of imagery is a contributor to increases in medical expenses.
- 80% of imagery reimbursement is for the technical fee (owning the equipment and taking the image) and 20% is for the professional fee (analyzing the image).
- In the past, a patient suffering from a softball ankle injury might be X-rayed, wrapped and prescribed Advil and rest for 10 days. Today a physician might likely also order an MRI. The patient feels comforted by the high-quality care, but at a much greater cost.
- Initial and operating costs are high for imaging equipment.
- CT and MRI scanner prices start around $1 million and go up.
- Greenville Radiology pays $800,000 per year on the service contracts for the equipment it owns and operates.
- Self-referrals by physicians are blamed for some of the rise in costs.
- In-office ancillary exemptions allow physicians to own imaging equipment. Some contend that this invites abuse by physicians self-referring to their own services. Physicians are likely to order more images if they own their own scanner.
- Financial incentives are in place for doctors to prescribe imagery at minimum intervals instead of as deemed necessary (i.e. - every 6 weeks vs. 6 months), each being paid by Medicare or insurance.
- Capping reimbursements rates encourages doctors to order more scans to recover the reduced technical fees on their equipment.
- When imaging reimbursement rates are cut, GRPA feels the brunt as they only scan patients who are sent to them.
- Proposed GRPA solution: “If you have any financial interest in a PET scanner ( positron emission tomography), a CT scanner or MRI, you are not allowed to refer your patients to that scanner.”
- Defensive medicine also drives the number of images. Physicians fear being sued and don’t want to miss that 1 in 100 case.
- Non-reimbursed and charity care at GRPA totaled $13 mil last year.
- Quality is how GRPA survives – “A bad exam is worse than no exam.”
- A bad exam can cause doctors to either miss a diagnosis (allowing the patient’s condition to worsen while feeling falsely secure) or to misdiagnose a condition (causing a patient to worry and be treated needlessly for a malady that doesn’t exist).
- If GRPA reads images taken at another facility, they often send staff members to that facility to help them improve their procedures.
- GRPA’s volumes have actually risen because of quality. Some groups (a cancer center and urology groups) own equipment at GRPA and send patients to GRPA for imagery by specialized radiologists.
- GRPA emphasizes that accreditation is in the best interest of the patients as it provides a standard of quality. If an orthopedic surgeon or urologist has a scanner, they should maintain the standards to keep quality high.
When: March 18, 2008
Where:
1210 W Faris Rd, Greenville, SC 29605
Hosts: Robin Freeman Spatafora, CHC (Assistant Administrator/Compliance Officer), Naveen Parti, MD, Chris McManus, MD, John Gilpin, MD, Rick Lawdahl, MD, Cindy Hipps, B.H.S., R.T.(R)(MR) (MRI Coordinator)
Background: "U.S. Health Care’s Technology Cost Crisis"