Radiology Coding, Reimbursement & Over-Utilization
My good friend Zeke recently wrote a great article in the JACR: "The Search for Misvalued Services: Why is Radiology a Target?" One aspect of "code mining" for "over-utilization" that is not addressed by anyone to date: Why does a utilization screen imply OVER-utilization and how? If, to use Zeke's example, an abdominal plain film Frequency is 30,000, perhaps there was a legitimate need for each of those films. Did they review the diagnoses (typically pain and/or obstruction) to determine which ones were over-utilized? How might the committee determine that one person's pain frequency was appropriate but another person exceeded the arbitrary threshold and prompted an unfair number of films? I find the whole discussion distasteful. I find the perspective that radiologists over-utilize incorrect and equally distasteful. Mostly, from within our ranks (e.g. Bruce Hillman's comment in the same journal) I find distasteful the perspective that radiologists have previously been well paid and should accept the decline in remuneration as a fair adjustment by society due to current economics. The truth is, as Zeke pointed out, that we radiologists have appropriately focused on fair reimbursement for per unit work. Such focus should not be penalized through arbitrary screens. We should examine the codes and help legislators identify reasons why the utilization numbers are what they are. THEN, if necessary, we might help to adjust various codes of all specialties to attempt to decrease healthcare costs.
It's not the study/code. It's the people who order the study/code that cause the costs to rise.
Paul Dorio
