Carolyn Meltzer
The ASNR Executive Committee and AJNR Senior Editors felt that it would be of service to our membership to provide concise descriptions of various aspects of health care reform legislation and associated market forces shaping our world. I assembled the first of these AJNR vignettes in the form of an introduction to the Patient Protection and Affordable Care Act of 2010.1 Over the following months, AJNR featured several additional in-depth vignettes on topics such as Accountable Care Organizations,2 Meaningful Use,3 the Independent Payment Advisory Board,4 the RUC or AMA/Specialty Society Resource-Based Relative Value Scale Update Committee,5 and a superb extended vignette on self-referral entitled “Alphabet Soup: Our Government ‘In-Action'”.6
The feedback from these vignettes has been highly positive. More than ever before, it is vital for neuroradiologists to be aware of the economic changes impacting our field. As pointed out in “Summary of the Affordable Care Act,” imaging reimbursement has been ground zero for government-targeted changes due to the rapid growth in imaging volumes and associated health care costs over the past decade. While that growth was due to a combination of innovative uses of imaging that took the place of more costly, invasive procedures, true overutilization, and the excesses of self-referral, the result has been across-the-board cuts to imaging reimbursement. This is also a time of great opportunity for us to champion evidence-based imaging use and needed comparative effectiveness research where evidence is lacking. We must lead in our national journey from a fee-for-service world to one in which we are measured by value delivery and improved patient outcomes. This will challenge us to be more efficient and eliminate waste wherever we can.
The highly active ASNR Health Policy Committee has continued to work closely with the ACR Commission on Neuroradiology to monitor relative value units (RVUs) associated with CPT codes in the Medicare Fee Schedule, inform efforts to develop quality metrics for risk-based payment constructs, and promote imaging decision-support tools for the practice of neuroradiology. Another result of this collaboration is the recent publication of an impactful “white paper” on imaging recommendations for the assessment of stroke.7 Responding to a clear need in the literature, this work addresses specific imaging approaches for relevant time windows after symptom onset.
Since the publication of the initial AJNR Health Care Reform Vignette, sequestration and the effects of a government shutdown have exerted further downward economic pressures on health care delivery systems