From Geoffrey Rose, an adult cardiologist and the Director of Medical Imaging at Carolinas HealthCare System’s Sanger Heart & Vascular Institute, in response to “As doctors flock to hospitals, bill spike” (Dec. 16):
The Charlotte Observer continued its reporting on the financial aspects of health care delivery, this time with a particular focus on cardiovascular imaging. The report highlighted the differences in patient charges and facility reimbursement that arise when services are performed in a practice setting (i.e., a physician’s office) versus a hospital-based setting. What wasn’t addressed, however, are the obvious questions – why do such differences exist, and how does this impact health care delivery?
First, some background. Hospitals and physicians did not create the payment structure; however, we must operate in the environment created for us. For almost 50 years, Medicare (operated by the federal government) has maintained separate payment structures for services offered in a hospital versus services offered in a physician’s practice. Hospital reimbursement has generally been higher, in recognition of the inherent complexity of the hospital environment, which is subject to more stringent regulations and has greater infrastructure costs.
So what changed? An aging U.S. population, along with new and more advanced technology, has led to unsustainable healthcare costs. This has resulted in not just an increase in overall spending, but a significant increase in Medicare spending related to medical imaging.
In order to control costs, Medicare cut reimbursements to physician practices offering medical imaging services, simultaneously increasing reimbursements to the hospital-based setting. These pay cuts have resulted in an elimination of imaging services in some physician practices because providers can no longer afford to provide the service. At Carolinas HealthCare System, however, we are able to provide the type of infrastructure needed to support many practices facing these financial challenges.
The net result of these national policy payment decisions has been the migration of medical imaging services into hospital-based systems. This vertical integration is viewed as a means to drive more efficient use of resources, reduce unnecessary testing, and improve access to medical information – factors necessary to promote healthcare quality while constraining its costs.
It is one thing to adapt, but it is quite another to lead. At Carolinas HealthCare System’s Sanger Heart & Vascular Institute, we developed a checklist to be used prior to ordering imaging tests, thereby assuring each physician of the appropriateness of the test order. We also helped author national guidelines on appropriate use of cardiovascular services and have been recognized for our work in this important area.
How we provide healthcare in this nation is undergoing transformation. Organizing operationally in this dynamic environment is complex and challenging. At SHVI and CHS, we subscribe to the Institute of Medicine’s “triple aim” of health care: improve the care provided to patients, improve the health of the population we serve, and reduce the growth in healthcare expenditures. Going forward, all stakeholders – patients, providers, policy makers, and payers – will need to work collaboratively to arrive at the health care delivery model that best achieves these aims.
The Charlotte Observer welcomes your comments on news of the day. The more voices engaged in conversation, the better for us all, but do keep it civil. Please refrain from profanity, obscenity, spam, name-calling or attacking others for their views.
Have a news tip? You can send it to a local news editor; email firstname.lastname@example.org to send us your tip - or - consider joining the Public Insight Network and become a source for The Charlotte Observer.Read moreRead less