A Little Less Conversation
A study¹ published in the October 24 issue of the New England Journal of Medicineadds to the growing body of proof that physician self-referral for imaging continues to occur—in some cases, to a staggering degree. A Georgetown University researcher found that urologists with ownership interest in intensity-modulated radiation therapy (IMRT) services are significantly more likely to recommend the procedure for their patients than physicians are if they have no financial stake in IMRT.
In fact, a prostate-cancer patient visiting a self-referring urologist is 518% more likely to receive IMRT than one seen by a urologist at a best-practice–certified National Comprehensive Cancer Network center is, the study found. IMRT utilization among urologists increases 246% when they become self-referring; using difference-in-differences analysis, the study’s author concludes that self-referral is responsible for fully 93% of the growth in utilization of IMRT.
Why should legislators even need this most recent study, though, when a July Government Accountability Officereport² found similar results for exactly same procedure—or, for that matter, when the administration’s budget proposal for the coming year recommends closing the in-office ancillary-services loophole? It pegs the potential savings at $1.8 billion, over a decade.
The reason is that our community is terrible at mobilizing. We have no problem at all identifying obvious problems such as self-referral, and we’re experts at feeling victimized when the over utilization mantle is placed unfairly on our shoulders. Rarely, however, do we actually do anything: We’re all conversation—no action. Some of us are reticent or assume that others will advocate on our behalf, but I think that the majority of our community is simply unaware of what it could be doing to create positive change.
In a few weeks, you’ll be at RSNA, drowning in a deluge of information about radiology’s shaky reimbursement outlook and its undefined role in future delivery models. You’ll be shaking your head in sessions and commiserating with colleagues in the exhibit hall—but please, if you can, arrive at the culminating event of the year in imaging both armed with this information and ready to share it:
Only 12% of ACR® members contribute annually to the college’s political-action committee, RADPAC. RADPAC contributions, however, have been shown—again and again—to yield results on Capitol Hill; this year, for instance, RADPAC’s staff was able to push for the inclusion of language regarding both the multiple-procedure payment reduction and clinical decision support in legislation to repeal the sustainable–growth-rate formula. It doesn’t get much easier than making a donation, and even a little bit of support can make a big difference.
By getting involved with local politics and lawmakers, radiologists can have a surprisingly strong impact on policymaking at every level. RADPAC schedules congressional visits to practices and imaging centers that help educate lawmakers on the importance of radiology to the care cycle. All you have to do is ask, and the visits take very little time. Joining a local hospital’s board (or taking a city-council seat) is an even better way to influence the policy ecosystem.
Further, radiologists can and should be taking full- or part-time appointed positions in national agencies, including theNational Institutes of Health, the Centers for Disease Control and Prevention, CMS, and the FDA. Not only can they use these positions to increase the visibility of the profession in the eyes of important decision makers, but they also can subsequently educate the radiology community on what they learned, shaping future efforts.
Of course, it must be mentioned, yet again, that radiologists should be actively seeking roles on their hospitals’ various committees—especially those involved in the development of accountable-care organizations or integrated delivery networks. Physicians in practice environments where productivity is valued above all else will struggle to contribute effectively to these groups, so time needs to be carved out for those who want to step up and advocate for their field’s piece of the future reimbursement pie.
With a little less conversation and a little more action, we can make incredible progress for this invaluable profession.
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.
1. Mitchell JM. Urologists’ use of intensity-modulated radiation therapy for prostate cancer. N Engl J Med. 2013;369(17):1629-1637.
2. US GAO. Medicare: higher use of costly prostate cancer treatment by providers who self-refer warrants scrutiny. http://www.gao.gov/assets/660/656026.pdf. Published July 2013. Accessed November 8, 2013.