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Legislation, Coalitions, and ASRT Priorities: What’s Next?

Legislation, Coalitions, and ASRT Priorities: What’s Next?. Christine J. Lung, CAE ASRT Vice President of Government Relations & Public Policy. Today’s Health Care Environment.

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Legislation, Coalitions, and ASRT Priorities: What’s Next?

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  1. Legislation, Coalitions, and ASRT Priorities: What’s Next? Christine J. Lung, CAE ASRT Vice President of Government Relations & Public Policy

  2. Today’s Health Care Environment • "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way…” • Charles Dickens, A Tale of Two Cities

  3. Health Care Reform Health insurance coverage for 32 million Americans. Estimated cost: $940 billion over 10 years. Estimated to reduce the deficit $143 billion over 10 years. Estimated to reduce Medicare annual growth 1.4% per year and extend Medicare solvency 9 additional years.

  4. What Does This Mean? • More insured = increased health care utilization? • Increased utilization = more imaging? • Aging of the population = increased health care and imaging utilization? • Will Congress continue to try to reduce imaging utilization through decreased reimbursement? • Will factors drive “advanced imaging” back to “standard imaging?”

  5. Utilization Rates Growth in advanced imaging and standard imaging until 2006 (DRA 2005). 19.2% reduction in spending on advanced imaging from 2006 to 2007. Utilization/spending continues to be an issue in Congress. Utilization is not driven by radiology; it’s a referral service. Tort reform?

  6. Radiation Mismanagement and Mistakes New York Times articles in February 2010. Public outcry against medical radiation exposure (I-131 therapy; RTT risks; CT dose; pediatric radiation). Patients cancelling examinations due to radiation fears. Context for risk/benefit.

  7. Congressional Hearing House Energy & Commerce Health Subcommittee on Feb. 26, 2010. Witnesses representing patients, medical physics, radiology, radiologic technology, equipment manufacturers and RBMs. MITA Radiation Dose Check Initiative. Alliance for Quality Medical Imaging & Radiation Therapy CARE Bill.

  8. Food and Drug Administration • FDA Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging (Feb. 2010). • Promote safe use of medical imaging devices. • Support informed clinical decision making. • Increase patient awareness. • Stakeholder meeting March 30-31, 2010. • FDA is limited to authority over equipment/software/training; not clinical use or operator qualifications.

  9. Medicare Improvements for Patients & Providers Act (MIPP A) • Facility accreditation standards for advanced diagnostic imaging (CT, MR, NM, PET) in January 2012. • Applies in settings seeking reimbursement for Medicare Part B technical component costs in PFS (IDTF/office/hosp. outpt.) • Joint Commission, ACR, IAC. • Increase exam quality and reduce utilization.

  10. Issues Increased demand; decreased reimbursement. Utilization remains a concern. Public outcry on radiation dose, mistakes and safety concerns due to recent media attention.

  11. Solutions Creation of a patient-focused quality and safety atmosphere for medical imaging and radiation therapy. Plan to address current and future access to care issues. Find new ways to “stretch” the health care dollar, e.g., do more with less.

  12. Access Balance “needed” care with “desired” care – appropriateness criteria; “right exam for the right reasons.” Application of new technology – EHR; reduce unnecessary repeat imaging. Explore the use of radiologist-extenders and expanding the R.T. scope of practice.

  13. Collaborative Efforts • Development of a team approach (radiologists, equipment specialists, R.T.s, physicists, extenders, practice managers). • Work with industry to create a common lexicon for dose measurement (CTDIvol, effective dose, relative dose index levels, weighted dose). • Development of effective safeguards to alert operators of excessive or deficient dose and need for technique adjustment.

  14. Collaborative Efforts • Revisit the “train the trainer” approach. • Pre-training, post-training assessment and remediation. • Engage the public. • Look to other industries for safety and quality assurance methods (e.g., aviation). • Include accrediting organizations in the discussions. • Benchmark and measure EVERYTHING!

  15. Partnership with Industry • Worksite productivity research, staffing level research, utilization and access research, cost-effectiveness research and patient safety research. • Development of safety and quality checklists. • Methods to help R.T.s make exams “better” for the patient. • Refine applications training methods. • Universal public support for technical personnel education and certification standards.

  16. Thank You • “The significant problems we face cannot be solved at the same level of thinking we were at when we created them.” • Albert Einstein

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