Why Healthcare is Moving to Value

Healthcare services and availability are changing due to the Affordable Care Act. ACA reforms are making better health care available to more people. States and the federal government are taking responsibility for payment to providers through Medicare and Medicaid so quality and higher-value services are most important.

Private healthcare insurance companies now have more subscribers and they expect patients to get the best service at the lowest cost. This includes diagnostic imaging and related testing.

According to the Medicare Payment Advisory Committee (MEDPAC):

"...studies have shown that a significant share of healthcare spending in the United States is wasteful; even if healthcare spending slows, much can be done to improve quality care while lowering costs per beneficiary."

Medicare

Medicare recipients are mainly seniors 65 and older along with some people on disability. Seniors have access to standard preventive care such as mammograms, colonoscopy and other diagnostic services at no additional cost. There will be more demand for imaging equipment as more "baby boomers" become eligible for Medicare.

Medicare is using Electronic Health Records transmitted to doctors by computers to avoid duplicating services. Hospitals, clinics, doctors and other facilities now have instant information on X-rays, other imaging and test results, prescriptions, surgeries and treatments for patients through EHR. This protects Medicare from double billing and patients from enduring duplicate consultations and testing procedures.

Doctors and medical facilities will be paid by Medicare based on the relative quality and cost of provided services. Coded billing is reviewed by Medicare and supplemental insurance companies.

Although Medicare Advantage Plans are not required of recipients, they are strongly encouraged by Medicare which pays 80 percent of services.

Care Centers

Many emergency and healthcare services are now offered through clinics and urgent care facilities. "Urgent" can refer to respiratory ailments, infections, cuts, bruises and fractures. These clinics and care centers often take the place of hospital emergency rooms.

Many care centers have diagnostic imaging equipment and doctors can have X-rays within minutes. They can set broken bones or decide if a patient should be hospitalized. Many urgent care facilities and clinics also have their own labs for urine analysis and blood work.

The demand for diagnostic imaging equipment and personnel will increase as more care centers become available. It's more efficient for care center doctors and patients to have imaging equipment and labs on site or nearby.

Ambulatory Surgical Centers (ASC)

Modern technology has made outpatient surgery at ambulatory surgical centers routine. More than 5,000 specialized ambulatory surgical centers accredited by Medicare and major health insurance companies are located in cities throughout the country.

Orthopedic surgery is an example of an ASC where a group of surgeons may have facilities for mending arms and legs within their office complex. They have X-ray, C-Arm and MRI equipment along with trained technicians and nurses.

Patients are home a short time after surgery, happy to avoid hospitalization. The surgical facilities have the space and equipment but they do not have the hospital's overhead. The cost is less per patient and the quality of service is more personalized.

Future Projections

The use of imaging equipment for exams and diagnosis is projected to grow by 13.6 percent Moving to Value over the next year as more people receive efficient healthcare. An estimated 61 million additional procedures will take place each year, many of them involving imaging. Many of the services will be offered at new care centers, ASCs and group practice centers. The need for trained imaging technicians and radiologists is also growing due to the ACA.