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January 15, 2007 • Volume 2 • Number 1

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Denial, Disbelief, and Anger

By Curtis Kauffman-Pickelle

One can no longer sugarcoat or deny the fact that radiology is a profession under siege. Many of those that I met with this past year across the country were scrambling simply to make sense out of the DRA cuts and in the process find ways to offset the financial hit. Most were a little stunned but held out hope that our industry representation in Washington, DC, would use its influence and skills to, if not outright reverse, at least delay such a draconian act. Hope faded and turned to denial and disbelief.

So here we are now in the first month of our new world order and it is anger that is starting its slow burn.

For me it started with the dashed hope that the "big tent" coalition known as the Access to Medical Imaging (AMIC) group would somehow use its purported Washington clout to bring reason to those legislators who seemed bent on, in the words of the coalition's leader Tom Scully, "whacking imaging." As the press releases continued their steady drumbeat of cost cuts, rate reductions, and "adjustments," it seemed that health care in general was under assault. Added to this was the uncertainty surrounding the impending physician fee schedule conversion factor reduction and it seemed as though everyone was getting whacked. In the end, there were winners and losers, and radiology was not among the winners.

The physicians dodged a bullet on the fee schedule adjustment primarily because the American Medical Association is a very strong lobbying organization. One felt the onset of "clout envy."

Then, an article in the Los Angeles Times on December 21st really turned up the heat on the slow burn.

Titled "Congress closes with a pork-filled flourish," the article's lead paragraph stated that "Christmas arrived Wednesday for the kidney dialysis industry….when legislation approved by the outgoing Congress included a $100 million-a-year boost in the Medicare reimbursement rates for dialysis providers."

Don't get me wrong, I am happy for the dialysis providers. They deserve the money. The part that got me worked up was the following quote from the same article: "The dialysis earmark, like other nuggets in the bill, had not been authorized by a congressional committee, and its addition to the tax bill was made final in a secret middle-of-the-night meeting in the waning hours of the session on Dec 7th. Dialysis scored 'not because dialysis patients have the most meritorious case,' said Sara Rosenbaum, professor of health law and policy at George Washington University, but because the industry 'is effective on Capitol Hill.'

Curtis Kauffman-Pickelle

The (dialysis) industry is effective on Capitol Hill! The article goes on to detail how influential the political action committees (PACs) are for this segment of health care and how their congressional champions did much of the heavy lifting on their behalf. Secret deals, behind-the-scenes lobbies, sustained pressure, being persuasive in making their case—in effect, the article outlines a clear strategy for being among the winners. And the clearest message of all is this: Radiology needs to do a better job of playing this game. The dialysis guys went right to the top, directly to the decision makers, and took their act into the big time by getting their story told directly to someone influential enough to make something happen on their behalf.

Home health agencies and home oxygen equipment providers were also among those whose cause was championed by key influencers on Capitol Hill and these two industries subsequently found favor in the final hours of this session as well.

So now we have two definitive meetings where imaging's interests were apparently not in the room. One secret session where we got whacked, and the second secret session where someone else got what they wanted. No staffers, no analysts, no mid-level functionaries. Just the people who can make things happen, who did make things happen for those who were in the room!

It is now well known and painfully obvious that the disparate forces representing diagnostic imaging in Washington have diverse and often conflicting interests, and that opinion leaders and those who control the reimbursement purse strings did not feel the collective pressure of a unified and organized profession until very late in the process. Interestingly, many would argue that this unanimity still does not exist. Pockets of effectiveness can be found in the outpatient arena as with the sustained efforts of National Coalition fro Quality Diagnostic Imaging Services. However, it alone cannot carry the water for an entire industry.

The AMIC needs teeth. It needs support. It needs each segment of radiology to embrace it and find ways to make the case that ours is a profession of key importance to health care, not a commodity that warrants the disrespect it was dealt. We need a congressional advocate and at least as much influence as the nephrology and the dialysis lobby.

Most of all we need to allow our disbelief to transform into anger that our profession was treated as such amateurs in the only game that counts in Washington—the power and influence game.

My commitment this year is to help find ways to help all of us get better at this process. I am interested in your ideas and welcome your thoughts on how to make this happen. Let's turn our anger into action and get something done this year.

Curtis Kauffman-Pickelle is a strategic business consultant to more than 30 imaging centers and radiology practices, the managing director of Practice Builders organization, and CEO of the Imaging Center Institute.