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Proyector: El director del reembolso para Philips habla reforma del cuidado médico

por Loren Bonner, DOTmed News Online Editor | July 25, 2013
Laurel Sweeney,
senior director of global reimbursement
for Philips Healthcare
DMBN: What do you do as global reimbursement director for Philips Healthcare?

LS: I work in the office of medical affairs, on the health economics and reimbursement front. So I'm responsible for reimbursement and market access for our technology and services. That includes understanding the clinical and economic evidence requirements of the financial stakeholder as well as the health technology assessment body. We also track changes in reimbursement policies and evidence requirements that will impact our products on the market.

DMBN: What do you think the imaging industry is paying most attention to these days as it relates to the changes going on in health care?

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LS: We're still operating largely in a fee-for-service environment and we have to look at the increasing budget pressures that will continue to make imaging a target for payment reduction. For example, there are really significant issues in the Medicare proposed fee schedules that came out that will affect imaging payments. In the physician fee schedule, which pays for freestanding imaging centers, they are proposing to change the formula that figures out that payment, which means they are changing the assumption that's used in the formula from 75 percent to 90 percent, which will make a difference in the overall payments for those settings.

In the hospital outpatient setting, Medicare is proposing to divide the diagnostic radiology hospital cost center into three separate buckets: MR, CT and "other" diagnostic radiology services. This is really going to affect the payment for CT and MR, especially CT in the hospital setting. A way to gauge that is a CT will be paid the same as an X-ray. So these are some big payment cuts. These are proposed rules so we're spending a lot time working with imaging partners and CMS on this issue. The final rule comes out in November and the comment period ends Sept. 1.

There is certainly this commonly held belief that what health care reform drives is that fee-for-service creates the wrong incentives because it's focused on volume rather than value. To improve quality and reduce costs you have to break down the silos of care. Both of these things have provided impetus for new polices that have affected things like value-based purchasing, readmission management and new models like bundled payments and shared savings agreements like ACOs. It impacts the imaging industry because it puts the focus on value. How is this imaging test going to impact care — that's really the question — and what's the incremental value of this imaging test? There's a huge emphasis on doing the right test at the right time. But I want to make the point that I don't really see any of this as threat to radiology because things like ACOs and bundled payment are really about reducing cost and improving quality and I see this as an opportunity for radiology to drive improvements and step in and take on a new role as the gatekeeper.

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