Rationale and Objectives
Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States.
Materials and Methods
To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this article, we review the expected features of the new health care environment from the perspective of academic radiology departments.
Conclusions
Our review will include background on accountable care organizations, identify challenges associated with the new managed care model, and outline key strategies—including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management—that will ensure continued success for academic radiology.
Continued growth in health care spending with a constantly aging population has propelled concerns about the solvency of the current health care system in the United States. Health expenditure has risen dramatically over the past 50 years (17.4% of gross domestic product compared to 11.4% for Canada in 2009); however, US health performance lags behind by comparison based on indicators such as life expectancy, quality, access, efficiency, and equity . Nonalignment of cost with performance triggered the 2010 panel discussion by the Institute of Medicine. Factors identified by the Institute of Medicine as contributing to the cost-performance nonalignment included prevalence of chronic disease, lifestyle, and population health demographics (such as the obesity epidemic), but also inefficient delivery of services (excess administrative costs, unnecessary services, high pricing, deficiency in preventive care, and fraud, amounting to $765 billion) . Furthermore, considerable variation in quality of care (as indicated by readmission rates per Medicare beneficiary) has been reported without correlation to regional costs .
In this article, we will broadly review the landscape of the new health care delivery environment from the perspective of academic medical institutions and anticipated impact on the future of radiology. Our review will include a background on accountable care organizations (ACOs) and challenges associated with the new managed care environment, use of technology for managing data-intensive environments, role of radiologists in medical innovation, defining new boundaries and roles for radiology in patient management, and implications of balancing academics and clinical care.
Patient Protection and Affordable Care Act
Payment reform is based on the premise that the current fee-for-service (FFS) payment incentivizes physicians to increase services with consequent excess utilization. Overuse of subspecialty services relative to perceived appropriate level of management in the primary care environment has resulted in the targeting of subspecialist physicians including radiologists and procedure-centric physicians such as interventional cardiologists or gastroenterologists. In an attempt to avoid overuse of imaging and subspecialist referral, several payment models have been put forward ranging from prospective payment for discrete episodes of care to global payment or risk-based care .
Direct Mechanisms for Reduced Reimbursement
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ACOs
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Payment Structure for Providers Under the ACO Model
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Providing Value for Radiology within an ACO
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Promoting Quality, Safety, and Best Practices
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Health information technology: A key to data management
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Data-Intensive Environment
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Connectivity, Interoperability, and Image Transfer
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Research and innovation in radiology
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Walking the Academic–Clinical Tight Rope
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Redefining radiology boundaries
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Service
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Quality Control
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Organization
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A Broader Picture of Patient Care and Information Management
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Radiologists as Consultants
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Direct Patient Communication
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Radiologist Management of Imaging Follow-up
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Imaging as the Basis of Subspecialist Referral
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Conclusion
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