Article Categories Health-and-Fitness Healthcare-Systems

How To Plan For Diagnostic Imaging Expansion With Healthcare Programs Being Uncertain

By: Charles Patti

Medical facilities are struggling to determine how to accommodate the uncertainty surrounding our current healthcare dilemma. The Affordable Healthcare Act (AHCA) was established to increase the number of people who would be insured to receive healthcare benefits, by as many as 30 million people, thereby increasing demand for diagnostic imaging services. However, the initial enrollment for these benefits have been somewhat disappointing with less than six million people applying, of which many have yet to obtain confirmed coverage and a substantial number of these people are switching from existing coverages they already had, but were canceled and forced to enroll under the new program. The net gain of new and previously uninsured enrollees - unknown, but we can safely assume these numbers are very low. Therefore, how do we determine if diagnostic imaging demand will increase or reduce? And how should we plan to accommodate this uncertainty?

We also must consider the reduction in reimbursements for most diagnostic procedures. The AHCA has established procedure guidelines and acceptable reimbursements schedules. These reimbursement schedules are also being adopted by public and private insurance providers as well. There would be no reason for them to provide coverages that exceed those mandated by government. Now we have to ask ourselves that if we reduce the number and kinds of tests we perform and then find a way to provide them at a lower cost - are we still offering the level of healthcare that is necessary to maintain the best available healthcare in the world? And will this result in an increase or decrease of required resources?

Another dilemma appears to be the continued decrease of available physicians. Reductions in Medicare and Medicaid reimbursements for physician services has also decreased. Combine those decreases with reductions that private and public insurance carriers have implemented and a significant number of physicians have opted for early retirement or alternative professions. Does the reduced number of available doctors effect the need to have additional testing available as remaining doctors are overloaded and can not spend sufficient time with patients to determine the most effective diagnosis?

The solutions are complicated and no one really knows where this will end but we can make some good calculated guesses. Firstly, if those who have lost insurance coverage are able to enroll and get coverage, the net loss to that group is minimal. If some that were not insured, now are, a slight gain may be experienced. Therefore, when evaluating the potential gain or loss of patients, we might assume the numbers don't change all that much (even though they were suppose to). Reimbursements are reducing, but if other costs, such as the lower cost of living, stable taxes and reduced equipment costs through enhanced technology - reduced reimbursements may be survivable. Lastly, the increase of Physician Assistances and Professional Nurse Practitioners may accommodate for the reduction of available physicians.

The bottom line is, make good business decisions when acquiring systems based upon historical numbers which don't seem to be changing much in spite of what we have changed and how things are now being done.

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