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CMS finalizes major cut in radiology reimbursement
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100 Replies
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Job market tanks next. Corporates get stronger.
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I dont know if more utitlization plus less reimbursement necessarily means corps get stronger. Smaller margin may hurt corps. This probably favors academic jobs and government/VA and make them more competitive.
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Doom and gloom paranoia. Same story for past 20 years. Yet it never comes. Let’s be appreciative and thankful for what we have.
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You get what you pay for and you pay for what you get
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Weve had major cuts before, and had a job market depression for years. It will happen again.
When reimbursements drop, radiologists will stop hiring. Corporates will offer lower salaries and fill their positions. Workload will go up as no one wants to see their salary drop.
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Angie Martinez. FP or radiologist?
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So instead of 600k, you’ll be making 540k?
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The TC gets whacked 10% too, so more consolidation, more corps.
600k to 540k? Just Medicare until the privates adopt fee schedule, so depends on your payor mix, so most likely will not be 10% off the bat, probably 5%. Increase in volume might offset the 5%, although pre-auth light might knock that down.
The problem is from here on out, Medicare’s insolvency will really start to show up. I think the projection is by 2024 it will run a trillion plus deficit, so these cuts will likely just keep coming, unless they institute a VAT tax or something to cover the costs.
Those who had supervision gigs will be out, a center will just go hire some cheap NP. The erosion of the supervision requirement is troubling.
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And everyone just rolls over and takes the cuts.
This is NOT the way to run ANY business, especially one that is dedicated to helping the sick.
We are in the Washington, DC area and frequently see patients from CANADA as there are very long wait times to schedule an MRI scan.
Respectfully, as we continue – as a group – to just TAKE THIS ARBITRARY LESSENING OF OUR SERVICES/COMPENSATION soon there will be NO ONE to serve our patients!-
^^ there are plenty of radiologists who will serve the patients even if pay was 1/2. Plenty of young indebted rads and older ones who made bad choices.
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I absolutely agree.
However…radiologists will have little to read if all the imaging centers can’t make their monthly payments for leases, maintenance, electricity, etc.
A very narrow view and ALL must be aware of the full process to be fully informed on total costs of providing services.
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Quote from irfellow2019
I dont know if more utitlization plus less reimbursement necessarily means corps get stronger. Smaller margin may hurt corps. This probably favors academic jobs and government/VA and make them more competitive.
Great point. There may be less investment into corporations due to their decreased profitability (lower margins). This is the second hit this year. This could slow their relative growth. Also it will be harder to acquire practices if they drop their salaries so this puts them in a tough spot.
We will be out of this recession soon and job growth, the number of people insured, and the demand for health services will increase. This should increase the number of jobs relative to the supply of radiologists.
Therefore it’s too early to make simplistic predictions on how this payment cut will affect the growth of corporates and the job market-
Yes. When the margins get thinner its better to keep the middleman out of the picture. PE valuations will decrease. Less tempting for practices sell.
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300 instead of 380
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Speaking as a group of independent imaging facilities, why don’t WE receive reimbursement based on quality, speed and good patient experience?
We can offer crappy service, marginal reports and awful patient experiences (some of our competitors do) and receive the same reimbursement. MADNESS.
Why would ANYONE want to invest in new technology if the OLD, MARGINAL equipment used pays the same reimbursement?
Who loses?
EVERYONE
This – as we all know – is NOT the marketplace speaking, it’s the government telling us what our services are worth.
And…if we could all band together and just say NO then we would receive appropriate reimbursement for our great investment in equipment, staff and most important quality plus patient safety.
Is this a draconian approach?
It isn’t if it makes the difference between providing quality service or slowly failing because of a non-business approach to reimbursements!-
Quote from William “Bill” Kisse
Speaking as a group of independent imaging facilities, why don’t WE receive reimbursement based on quality, speed and good patient experience?
Do you want to design and monitor that reimbursement system?
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SOMEONE must do it!
Why can’t our RBMA association take the lead?
WE MUST START SOMEWHERE!
Would you be willing to help me/us in this most honorable approach?
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Realistically where does this put salaries? Still too early to tell?
Asking as a PGY2 with significant educational loans (300K+)
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^^^. Look at current salary averages and go down from there 10% or so. Since you got many years before your working as attending, go down even more. There will be more cuts.
Much more likely to be working employed jobs in future with lower salaries. Youll also be reading more volume. Sorry, bad time to be entering radiology. But good thing is you wont know any better.
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Never an optimal time to enter [u]any[/u] profession, but unless you pick a really dead-end profession (of which medical IS NOT) do so with passion, dedication and personal satisfaction.
IMHO that’s the path to success no matter your choosing.
Wishing you the best of success meeting your goals.
ANYTHING in the medical profession is an honorable endeavor and worthy of consideration.
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Like Rads1991 I am also a trainee with mega debt to pay. Even mid 100s is better than starting a new career, even if its grossly underpaid. Super bummer. Hard not to feel like weve been taken advantage of.
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If you want to feel better, I’m sure you can find threads about how Obamacare was for sure going to put every rad in the poor house
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Income will drop, but not drastically. The morons in government who institute these changes think lower reimbursement will decrease ordering. They are too dumb to realize that those who order radiology imaging could care less what we get paid. Therefore imaging volumes will continue to grow.
An earlier poster stated that many rads would continue to work even with 50% reimbursement cut. That is probably true, but there is already a borderline shortage of radiologists. This legislation will definitely drive some rads to retire and fewer med students to choose radiology.
This all means a desperate shortage of rads will develop and hospitals will pay a premium to hire rads. Radiology will go from being a profit center to a cost center for hospitals. They will shift profits from other departments to radiology instead of the other way around. That or the system collapses.
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Doesnt seem like its a done deal yet. Congress can still waive the budget neutrality. 50 Senators wrote a letter in support (see link below).
[link=https://www.radiologybusiness.com/topics/healthcare-economics/bipartisan-senate-supports-stopping-radiologist-medicare]https://www.radiologybusiness.com/topics/healthcare-economics/bipartisan-senate-supports-stopping-radiologist-medicare[/link]
Everybody please email your senators to hopefully get this cut delayed or at least reduced. -
Not sure if this link will work – but rad partners set this up to contact your representative — give it a shot/ May have to copy and paste
[link]https://app.muster.com/take-action/yZhLhwmW5d/[/link] -
Quote from La Dolce Vita
Not sure if this link will work – but rad partners set this up to contact your representative — give it a shot/ May have to copy and paste
[link=https://app.muster.com/take-action/yZhLhwmW5d/]https://app.muster.com/take-action/yZhLhwmW5d/[/link]Not a huge fan of the corp outfits but must say they are on top of this stuff. They’re also closely monitoring a surprise medical bill fix (from Pelosi) which would be a much larger hit then 10%CMS as it would allow private insurers to set rates
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I skimmed the new rules so I’m not 100% but sorta good news:
“In addition, for residency training sites of a teaching setting that are outside of an MSA, the CY 2021 PFS final rule allows teaching physicians involving residents in providing care at primary care centers to provide the necessary direction, management and review for the residents services using interactive, real-time audio/video communications technology. For these sites, residents furnishing services at primary care centers may furnish an expanded set of services to beneficiaries, including communication technology-based services and inter-professional consults.”It sounds so vague so I’m not exactly sure but it sounds good?
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Quote from fumoney
This all means a desperate shortage of rads will develop and hospitals will pay a premium to hire rads. Radiology will go from being a profit center to a cost center for hospitals. They will shift profits from other departments to radiology instead of the other way around. That or the system collapses.
100%
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Quote from fumoney
This all means a desperate shortage of rads will develop and hospitals will pay a premium to hire rads. Radiology will go from being a profit center to a cost center for hospitals. They will shift profits from other departments to radiology instead of the other way around. That or the system collapses.
Or simply quality will go down. You get what you pay for. CT AP w dictation eventually will only read: “Impression: no acute abnormality.” We now live in a world where people compete on price, not quality.
Quote from Cubsfan10
I’ve thought about an RVU limit a lot and ultimately I think it’s one of those things that sounds great in theory but would be disastrous in practice.
– Who picks up the extra studies that don’t get read? Radiologist shortage and quickest solution would be rapid adoption of midlevels/AI
What about putting the ball back in the ordering provider’s court? They order too many studies knowing there is a finite amount of work the staff can do? Simple put a canned “No radiologist report will be provided. Images obtained only without interpretation.” Bill technical only, no professional component, and make the ordering provider deal with it. That should scare Medicare and others quickly unless they truly think radiologists don’t add value. -
Quote from ztune
Quote from fumoney
This all means a desperate shortage of rads will develop and hospitals will pay a premium to hire rads. Radiology will go from being a profit center to a cost center for hospitals. They will shift profits from other departments to radiology instead of the other way around. That or the system collapses.
Or simply quality will go down. You get what you pay for. CT AP w dictation eventually will only read: “Impression: no acute abnormality.” We now live in a world where people compete on price, not quality.
Quote from Cubsfan10
I’ve thought about an RVU limit a lot and ultimately I think it’s one of those things that sounds great in theory but would be disastrous in practice.
– Who picks up the extra studies that don’t get read? Radiologist shortage and quickest solution would be rapid adoption of midlevels/AI
What about putting the ball back in the ordering provider’s court? They order too many studies knowing there is a finite amount of work the staff can do? Simple put a canned “No radiologist report will be provided. Images obtained only without interpretation.” Bill technical only, no professional component, and make the ordering provider deal with it. That should scare Medicare and others quickly unless they truly think radiologists don’t add value.
I would imagine that the ED already tracks these numbers but I would guess that one would have to be an extreme outlier to stand out from the rest. Also unsure of ramifications from over-ordering if any -
Received a call to action email from a friend which stated the following info below. So with the recent E/M cuts this year (?4-5%) which will ultimately hit 10–11%, we are looking at 16-17% CMS cuts? How did the 1.9T stimulus trigger a -$36B Medicare cut? These ridiculous cuts are getting out of hand. Cant see how CMS/medicare are sustainable. We’re looking at skyrocketing demand by seniors with perpetual decreasing reimbursements. Seems a$$ backwards. Maybe time to perform major CMS/medicare reform.
[b][b]The House Rules Committee[/b] is scheduled to meet today to review [u][b][link=http://click.sf.zotecpartners.com/?qs=0b16da46048f9ab0288d386b0755e455e7a4c4329b8d322a7b2752dc0df5a4a2351c440b536856232a36c5a0c7beebb7b2beb6ba9b214e22]H.R. 1868[/link][/b][/u], which addresses the -2% sequestration cuts; this provision kicks in on 4/1/21. Also, due to the recent passage of the American Rescue Plan ($1.9T stimulus), and under the Pay as You Go (PAYGO) rules, a -$36B cut in Medicare would be triggered early in 2022 — most likely in January. [/b][b][b]The Senate [/b]has introduced [b][u][link=http://click.sf.zotecpartners.com/?qs=0b16da46048f9ab0154a4a63a4c6a04dec0b3144286de6ce24615bd0b6e5cd0a9f37601abab54caecb665fbf2b0623195a9aea4033dbf232]S. 748[/link][/u][/b]- [i]Medicare Sequester Relief Act[/i], a bill to provide for an extension of the temporary suspension of the -2% cut through the COVID-19 Public Health Emergency (PHE). However, this doesnt address the PAYGO cuts.[/b] [b]This means that without congressional intervention there will be a [b]-6% cut to the Medicare Physician Fee Schedule (MPFS) in addition to the cuts that took effect at the beginning of this calendar year.[/b][/b]
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Ha, have a pandemic and give away free money to everyone but the physicians who helped treat the patients. Solid.
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Cubsfan stole my words. A little disappointing.
In our areas, we even had some “research” or news articles talking about how physicians are overpaid just 2-3 months ago. Some insurance reimbursement retrospective reviews. It was really nice hearing so many folks saying “you guys are heroes for being at the frontline,” yaddy yadda with COVID. And then they turned around and basically said, “but don’t you think you guys get paid too much?”
I am pretty early in my career but sometimes tell my spouse I don’t know if I will make it to “typical” retirement age. Maybe next 10-15 years, it might not be worth it. -
Your position and sincerity are appreciated, even refreshing. I agree with all you wrote on this.
However, in talking with one of my colleagues who works closely with the ACR, he told me that less that 10% of rads actually responded with writing letters.
We have met the Enemy, and he is US. -
i wonder if the acr has people who call up the big groups’ point person and say
please have all your rads write letters – this is important
is there much communication between acr/radpac and the bigger groups? and would the president of said groups demand that partners/associates engage?
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makes me wish we had an analogue of the checkoff programs that agribusiness has to make everyone put some resources in to further the cause
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Quote from stephenhumes
Your position and sincerity are appreciated, even refreshing. I agree with all you wrote on this.
However, in talking with one of my colleagues who works closely with the ACR, he told me that less that 10% of rads actually responded with writing letters.
We have met the Enemy, and he is US.
Difficult to justify that pathetic response rate. The letter is already written, just a minute to enter some information. Maybe that’s why specialties such as cards are perceived to have a “better” lobby, their members actually take action. I wonder what % of rads are P/E? I would think leaders in those groups would crack the whip to get everyone to participate.
Conclusion is either rads don’t care about CMS cuts or they believe that these tactics do not work. Not to overgeneralize but during training many of my attendings felt protected from CMS cuts and viewed them as more of a private practice issue. -
Quote from jd4540
Quote from stephenhumes
Your position and sincerity are appreciated, even refreshing. I agree with all you wrote on this.
However, in talking with one of my colleagues who works closely with the ACR, he told me that less that 10% of rads actually responded with writing letters.
We have met the Enemy, and he is US.
Difficult to justify that pathetic response rate. The letter is already written, just a minute to enter some information. Maybe that’s why specialties such as cards are perceived to have a “better” lobby, their members actually take action. I wonder what % of rads are P/E? I would think leaders in those groups would crack the whip to get everyone to participate.
Conclusion is either rads don’t care about CMS cuts or they believe that these tactics do not work. [b]Not to overgeneralize but during training many of my attendings felt protected from CMS cuts and viewed them as more of a private practice issue. [/b]
This is the reason. And the apathy of the rads in corporate. Not much leftover after that. I’m not surprised it was 10%. -
[link=https://www.apta.org/article/2020/12/09/fightthecut-update]https://www.apta.org/arti…/09/fightthecut-update[/link]
Maybe some hope – senate interest in a bill
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It takes less than a minute to send letters to your Senators (ACR and others have made it simple). As with voting, turnout matters. Take a minute and do so– this zero sum game among providers isn’t the answer to the problems with our healthcare system.
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If any movement or good comes out of Auntminnie, this should be it. I wonder if we can mobilize a lot of people to have people send letters and make phone calls. Maybe we can summon r/medicine in reddit and r/medicalschool also..
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You can probably search these forums, this kind of thread comes out at least once a year with the same message. Nothing really ever comes of it, we still get cuts. I bet you this kinda post has happened almost every year for the past 10+ years
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Look at this chart. I charted the conversion factors over time.
Factoring in inflation, this is absolutely bad.
If this is not concerning to you, then I don’t know what is.
Edit:
We gotta fight the “This happens every year” sentiment!!
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Let me preface what I am about to write by stating that I did sign the ACR letter and submit.
That being said, if 100% of radiologists signed it would that really make a difference? If 100% of all physicians being affected did so would that make the difference?
Maybe but I doubt it. Continuing cuts to health care seem destined to continue.
Pharma avoids cuts not by signing friendly letters to congressmen. They do so through massive expensive lobbying efforts, buying off politicians. Also it was before my time but when the Clintons in 1993 tried to pass health care reform the pharma industry defeated it with a massive direct to consumer advertising campaign that scared voters.
So, I dont think the letters will help. I think there are 3 ways to protect ones interests in our political system. One is massive amounts of money. I doubt our lobbying groups could ever compete with the lobbying money from other industries. Another is be part of a massive voting block. Physicians are a tiny voting block. A third way is to unionize or threaten to take something away.
The only way I see doctors ever regaining any power is to unionize, limit services or quit en masse.
I personally dont need to be paid a higher salary. I just think more work for lower reimbursement is reaching a breaking point. Doctors are the kid on the playground who gets beat up for his lunch money every time the government addresses health care costs. Meanwhile, pharma and all the other major players are on the playground watching while they eat their enormous lunch complete with twinkies, dunkaroos, fruit by the foot and all the other stuff I always wished I had for lunch as a kid.
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You are correct fumoney
We have bigger fish to fry in the nation within 5 years, and I think just within 2 now. This will be a weird, wild, and violent decade for either the US and/or the world. -
You owe me money
When are you paying
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Quote from fumoney
Let me preface what I am about to write by stating that I did sign the ACR letter and submit.
That being said, if 100% of radiologists signed it would that really make a difference? If 100% of all physicians being affected did so would that make the difference?
Maybe but I doubt it. Continuing cuts to health care seem destined to continue.
Pharma avoids cuts not by signing friendly letters to congressmen. They do so through massive expensive lobbying efforts, buying off politicians. Also it was before my time but when the Clintons in 1993 tried to pass health care reform the pharma industry defeated it with a massive direct to consumer advertising campaign that scared voters.
So, I dont think the letters will help. I think there are 3 ways to protect ones interests in our political system. One is massive amounts of money. I doubt our lobbying groups could ever compete with the lobbying money from other industries. Another is be part of a massive voting block. Physicians are a tiny voting block. A third way is to unionize or threaten to take something away.
The only way I see doctors ever regaining any power is to unionize, limit services or quit en masse.
I personally dont need to be paid a higher salary. I just think more work for lower reimbursement is reaching a breaking point. Doctors are the kid on the playground who gets beat up for his lunch money every time the government addresses health care costs. Meanwhile, pharma and all the other major players are on the playground watching while they eat their enormous lunch complete with twinkies, dunkaroos, fruit by the foot and all the other stuff I always wished I had for lunch as a kid.
Glad you submitted the letter. I def hear you about relentless cuts and pessimism about our lobby. The main difference this time around is that there is a “coalition” of physicians from different specialties “banding” together (I’m not quite sure myself if I am being facetious or not), but I do think its worthwhile to submit these letters and encourage colleagues to do so as well.
No breaking news here but the main difference between physicians and Pharma, is that they are a faceless corporation that has mega-bucks, with a worldwide market/product with R/D that is funded by the US consumer. Politicians are all the same at their core (power/influence and re-electability) so this dysfunctional symbiotic relationship persists. Capitalism and opportunity for upward economic mobility has been very positive for both the country and individuals. It seems however that we are reaching breaking points-including the one that you alluded to. CMS’s trust fund becomes insolvent in 2024. I have no idea what the real-world ramifications of this is, just as I have no idea what the significance of our nation’s enormous debt is, but it looks/sounds bad. I know I am rambling, guess my main point is that our HC system/overall economy seem like they are both about to fall off a cliff. Too many conflicting interests/needs where the math simply does not add up. -
another difference
physicians are divided
you can get 5 ceos in a room and they could speak with authority(power) re their industry
lot easier to get all their resources pulling in the same direction
also they don’t apologize (to the degree we do) about making money- makes it easier when they can invoke their shareholders “bosses”. they have relative purity of motive
finally – they take it as a given that they will need to negotiate with government etc. We sometimes might act as if we are above that (reality) . ” we take care of patients for gods sake. don’t trouble us about that unseemly bs”
ie we refuse to acknowledge that a game is being played and so we play it terribly
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Quote from illinois
another difference
physicians are divided
you can get 5 ceos in a room and they could speak with authority(power) re their industry
lot easier to get all their resources pulling in the same directionalso they don’t apologize (to the degree we do) about making money- makes it easier when they can invoke their shareholders “bosses”. they have relative purity of motive
finally – they take it as a given that they will need to negotiate with government etc. We sometimes might act as if we are above that (reality) . ” we take care of patients for gods sake. don’t trouble us about that unseemly bs”
ie we refuse to acknowledge that a game is being played and so we play it terribly
Great points.
I don’t think I’ve ever seen senate/house bills directly aimed at curbing cuts. I may be wrong but in the past any decrease in cuts in the final CMS fee schedule has always come from CMS directly? Biggest difference this time is that we are part of a larger coalition of physicians (I got an ACR email saying that over 14K physicians have contacted/emailed their representatives.)
My point about capitalism is kinda related to your last 2 points. Physicians have/still are doing well financially. For myself it certainly has lead to upward mobility compared to my parents. Despite the cost of medical education and the cost in years during training (disconnected work/compensation ratio), cost/risks associated with malpractice, as a group physicians look bad/greedy when we start complaining about money/reimbursement (corporate model being the exception).
With that said we are reaching a breaking point w/volume and burn-out to maintain income, CMS is running dry, the need for healthcare services is rising as our population gets older, education costs are rising, many people still don’t have access/coverage, and I think most of us that have been privately insured can attest to some dissatisfaction with coverage/getting shafted by our insurers. I can’t see an easy solution to address these issues bc the math does not add up. Best option my be getting CMS/3rd party insurers totally out versus Govt/CMS totally taking over. Hard to see getting insurer’s totally out given their influence though. Also not sure how politicians/public will cope with increase wait times/decrease in service that would likely come with a Govt run system. -
I agree with your view
However I think sometimes we project when we talk about greedy doctors . And Im not sure it matters much. Many industries have done just fine lobbying even with an image problem. Anything can be spun any which way . Im also not sure how much it matters that we dont see patients.
Imo we start with plenty of advantages that other industries havent had but have done just fine
We have been complacent , make excuses why things are turning against us and resign ourselves to failure instead of scrapping so to speak . Thinme are getting tight and if we want to preserve our position we will have to fight. Many of us dont have much experience in self promotion and I imagine that is reflected in our leadership – it is like we are all just kind of happy to be here.
I think a lot of industries leadership basically says lets get a ton of $ together hire some talented PR people to spin things in our favor and direct the money where it can help us ie lobby
I heard something recently re agribusiness that they get 2k in benefit for every lobbying dollar . Im not sure about that figure but given the astronomical sums spent Im sure it is excellent return
Makes me wonder how good our radpac people really are .
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Quote from rads1991
Realistically where does this put salaries? Still too early to tell?
Asking as a PGY2 with significant educational loans (300K+)
It’s too early to tell
Supply and demand will affect salaries. There are too many factors to make a prediction at this time. Simplistic prediction models are inaccurate.
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Quote from 67ED5CC042435
At the end of the day, we will end up reading 10% more studies for same pay until the insurance companies and hospital systems decide AI + non-physician signing off is good enough for their customers.
It’s called technological progress.
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What other specialties reimbursement is being cut? Are others being cut less than radiology?
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Quote from radsres1234
What other specialties reimbursement is being cut? Are others being cut less than radiology?
Rads and Anesthesia both around 10%, ER around 6%, critical care around 6%, path also but not sure how much. Basically largely hospital based specialties which have more or less been on the front line versus Covid. Basically the same specialties that would be scr*wed by the surprise medical bill fix….Some surgical subspecialties are getting hit but not as hard -
I would recommend everyone curious about finalized CMS policy to check this out:
[link=https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1]https://www.cms.gov/newsr…hedule-calendar-year-1[/link]
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Cards raise 1.1% – some of the biggest self referring scammers
Ortho cut 5 percent
Ducking BS
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[link=http://www.ciproms.com/2020/11/industry-groups-legislators-hope-to-reduce-impact-of-medicare-budget-neutrality-for-2021/]http://www.ciproms.com/20…t-neutrality-for-2021/[/link]
[ul][*]Anesthesiology: -8%[*]Cardiac Surgery: -9%[*]Chiropractic: -10%[*]Emergency Medicine: -6%[*]Interventional Radiology: -9%[*]Nurse Anesthetists/Anesthesiologist Assistants: -11%[*]Pathology: -9%[*]Physical Therapists/Occupational Therapists: -9%[*]Radiology: -11% [/ul]-
Why is someone named Angie martinez questioned whether or not she is a radiologist?
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Glad my spouse is a dermatologist.
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Never understood why anesthesia paid so much. How is it possible they are paid more than most of their surgeons?
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For reference of all specialties, see attached.
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Quote from Coffeebrewer
For reference of all specialties, see attached.
Thanks for posting that chart
It’s suprising to me how broad based the cuts are to specialists
How are the winners and losers determined? How are the people that determine the winners and losers selected?-
Its just based on E/M coding and budget neutrality. So this year, docs who see lots of patients in clinic got a bump and in order to stay budget neutral everyone else got cut. The AMA does the codes. Budget is congress.
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Cardiology does very good at avoiding cuts because they have strong lobbyists. ACR is the exact opposite. Radiology has been going downhill for years, a lot of aunt minnie members give bad advice when medical students on here ask about choosing radiology is their specialty. Medical students seem to be smarter than the board members on here as interest in radiology declines year after year.
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As payment per unit of radiology work decreases, as it has been doing for about a decade, the best course of action is to work less rather than try to read even more volume to make up for the decrease. I feel for those younger Rads that have a lot of debt and are just getting started as the $$ is slowly drying up. But if you are an established Rad with a decent next egg, this would be a good time to consider trading money for time off…. as our work is being devalued it makes this trade better for us and could lengthen our careers / diminish burnout.
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Our work is devalued by everyone and it’s our own fault.
Hospitals/admins see us as a commodity/lab test
Patients don’t even know what we do/who we are
Clinicians think we sit around lazy all day and constantly question everything we do. Just imagine if we treated clinicians they way they treat us. “Hey I was reading your clinic note and you said the patient’s mole was on the left arm, but it’s really on the right. Could you add an addendum?”
Too many apathetic beta people in this field for 50 years that got walked all over by everyone.-
Quote from Cubsfan10
Our work is devalued by everyone and it’s our own fault.
Hospitals/admins see us as a commodity/lab test
Patients don’t even know what we do/who we are
Clinicians think we sit around lazy all day and constantly question everything we do. Just imagine if we treated clinicians they way they treat us. “Hey I was reading your clinic note and you said the patient’s mole was on the left arm, but it’s really on the right. Could you add an addendum?”
Too many apathetic beta people in this field for 50 years that got walked all over by everyone.
I get your point but I think a lot of this depends upon where you work. Our ER is extremely busy (top 10 in the country last time I checked), and often times our reads determine whether the patient is admitted/DC’d. Anytime an ER attending calls, the 1st thing they say is sorry to bother you, I know your busy but can you please take a look at…. In fact most clinicians interact with us that way and are extremely grateful if you give them a few minutes to review scans (which is basically our job). Without radiology, hospitals would cease to function pretty quickly.
Also if you want patient recognition/gratitude start doing diagnostic breast imaging and/or procedures, or even just flouro cases. Earlier this year a tech and I received a 2 page letter from a women we did a BE on, expressing her gratitude with respect to how we interacted with her, made her feel comfortable, and explained everything along the way.-
Left/right discrepancy is a big deal IMO. I know another rad who got it wrong and the urologist took out the wrong kidney. Then he obviously still had to have the other kidney removed. Died on HD. Everyone is getting sued.
So when clinicians call about left/right, male/female, etc I thank them for the call.
Also, most grateful patients are therapeutic join injections. They think youre amazing.
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I think you have some good points.
But most ED reads are not paid. You get paid 100% maybe for the first study but then goes down hill. You might get less than 40% of your reads be paid fully.
One of the reasons to get out of the reading room and do those procedures. Lots of ACR members want to accept PAs/NPs/RAs into the procedure rooms so radiologist have more time to read. Well here is a great example of how that doesnt really help the profession. Yes, it helps your pocket.
The only time a rads is seen by a patient usually is procedures.
So go out there and sling some barium, stick a needle into a joint, a lumbar area, thyroid etc.. Dont say, it is a waste of time and PAs/RAs/ should do them. Not only will they become better and the go to person, they will be seen by patients as the radiologist in time, IF lazy rads dont go out and do them.
Quote from jd4540
Quote from Cubsfan10
Our work is devalued by everyone and it’s our own fault.
Hospitals/admins see us as a commodity/lab test
Patients don’t even know what we do/who we are
Clinicians think we sit around lazy all day and constantly question everything we do. Just imagine if we treated clinicians they way they treat us. “Hey I was reading your clinic note and you said the patient’s mole was on the left arm, but it’s really on the right. Could you add an addendum?”
Too many apathetic beta people in this field for 50 years that got walked all over by everyone.
I get your point but I think a lot of this depends upon where you work. Our ER is extremely busy (top 10 in the country last time I checked), and often times our reads determine whether the patient is admitted/DC’d. Anytime an ER attending calls, the 1st thing they say is sorry to bother you, I know your busy but can you please take a look at…. In fact most clinicians interact with us that way and are extremely grateful if you give them a few minutes to review scans (which is basically our job). Without radiology, hospitals would cease to function pretty quickly.
Also if you want patient recognition/gratitude start doing diagnostic breast imaging and/or procedures, or even just flouro cases. Earlier this year a tech and I received a 2 page letter from a women we did a BE on, expressing her gratitude with respect to how we interacted with her, made her feel comfortable, and explained everything along the way.
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Quote from Cubsfan10
Patients don’t even know what we do/who we are
Went in to see a patient once and he said, “oh are you the radiologist? Or the physician?”-
It’s a decrease in the conversion factor of the MPFS, so in theory should apply across the board to professional, technical and thus global.
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Quote from RadJedi
Quote from Cubsfan10
Patients don’t even know what we do/who we are
Went in to see a patient once and he said, “oh are you the radiologist? Or the physician?”
I’m assuming that wasn’t while you were doing breast or a procedure. Never had a patient question if I was a physician while I was consenting/explaining X procedure where I was going to be placing a biopsy needle into X organ.-
Quote from jd4540
Quote from RadJedi
Quote from Cubsfan10
Patients don’t even know what we do/who we are
Went in to see a patient once and he said, “oh are you the radiologist? Or the physician?”
I’m assuming that wasn’t while you were doing breast or a procedure. Never had a patient question if I was a physician while I was consenting/explaining X procedure where I was going to be placing a biopsy needle into X organ.
It was ultrasound in residency a while ago… not sure exactly how it came about. But good points about introduction, I must not have said Dr… but that cant be right. Maybe he didnt hear me? Regardless, he didnt know radiologists were physicians.
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Pelosi gives up on surprise medical bills, physician backed mediation framework will likely get passed. So we can keep raping the patients for time being.
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Quote from avocado
Pelosi gives up on surprise medical bills, physician backed mediation framework will likely get passed. So we can keep raping the patients for time being.
“We” would imply you were a radiologist, and in the least a MD. Please don’t insult us by associating yourelf with us.
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Shouldnt Avocado be thrown out for that post?
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Avocado is the most annoying troll on this forum…I have him blocked already but I agree with fumoney…he/she needs to be banished from this forum
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This is great news, it would have been much bigger cut than the CMS adjustment. Thank Richard Neal, a Democrat holdout in the House, as well as Republicans leading this effort overall.
There’s still a big risk of ongoing Congressional assaults on Physicians next year once Ossoff & Warnock are installed come January. Keep the pressure up on your representatives.
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How do you block somebody?
The instructions should be a postscript on each of avocados posts
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Quote from avocado
This is great news, it would have been much bigger cut than the CMS adjustment. Thank Richard Neal, a Democrat holdout in the House, as well as Republicans leading this effort overall.
There’s still a big risk of ongoing Congressional assaults on Physicians next year once Ossoff & Warnock are installed come January. Keep the pressure up on your representatives.
Thanks for the update Avocado…this is latest from ACR: very credible effort to include surprise medical billing (SMB) legislation in an end of the year package. Legislative language has improved but still several important concerns that need to be addressed…
Not quite sure of the status of the 10% CMS cuts
Have not been following the GA run-off but I’d be surprised if any party sweeps.
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Quote from RadJedi
Quote from Cubsfan10
Patients don’t even know what we do/who we are
Went in to see a patient once and he said, “oh are you the radiologist? Or the physician?”
Ive never been questioned that I was the physician by the patient. Not even in residency. Typically you enter the room and introduce yourself first. Hopefully you say Im Dr. So and so… and the tone of the encounter is set.
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Quote from striker79
Cardiology does very good at avoiding cuts because they have strong lobbyists. ACR is the exact opposite. Radiology has been going downhill for years, a lot of aunt minnie members give bad advice when medical students on here ask about choosing radiology is their specialty. Medical students seem to be smarter than the board members on here as interest in radiology declines year after year.
I think a major advantage that specialties like cards have over rads is that they see patients, and that they can be a huge money maker for hospitals (such as EP) so I’m sure they get support from the hospital lobby as well.
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No way Envision can now pay 29 per RVU when conversion factor goes from 36 to 32.
Corp rad slaves are going to make even less now.-
I would like to see the ACR put out a paper with recommendations on rvu limits per radiologist. Something like a maximum shift length of 9 hours and a maximum of 55 rvus per shift. 55 rvus probably translates to around 100-125 cases mix of plain film and cross sectional.
Why? Because fighting reimbursement cuts has been a total failure. I wrote in an earlier post doctors can only win this battle against lower pay for more work by striking, quitting or limiting access. If rads all stopped reading after x rvus there would be an acute under supply of rads, a back log of cases and it would show just how important our work is. This in turn would make govt think twice about further cuts and pressure employers to treat rads well.
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Quote from fumoney
I would like to see the ACR put out a paper with recommendations on rvu limits per radiologist. Something like a maximum shift length of 9 hours and a maximum of 55 rvus per shift. 55 rvus probably translates to around 100-125 cases mix of plain film and cross sectional.
Why? Because fighting reimbursement cuts has been a total failure. I wrote in an earlier post doctors can only win this battle against lower pay for more work by striking, quitting or limiting access. If rads all stopped reading after x rvus there would be an acute under supply of rads, a back log of cases and it would show just how important our work is. This in turn would make govt think twice about further cuts and pressure employers to treat rads well.
I totally agree.
I am in academics and sometimes read 80-100 pure cross sectional studies in 8-9 hours with majority of studies having findings and frequently complex. That is pretty much upper limits of what we can tolerate even with residents help, because we still have to review all the cases.-
That is a crazy volume for academics or any practice.
Mostly negative case mix would be soul crushing for 10-12/hr.Makes me appreciate my job even more
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Quote from Voxel77
Quote from fumoney
I would like to see the ACR put out a paper with recommendations on rvu limits per radiologist. Something like a maximum shift length of 9 hours and a maximum of 55 rvus per shift. 55 rvus probably translates to around 100-125 cases mix of plain film and cross sectional.
Why? Because fighting reimbursement cuts has been a total failure. I wrote in an earlier post doctors can only win this battle against lower pay for more work by striking, quitting or limiting access. If rads all stopped reading after x rvus there would be an acute under supply of rads, a back log of cases and it would show just how important our work is. This in turn would make govt think twice about further cuts and pressure employers to treat rads well.
I totally agree.
I am in academics and sometimes read 80-100 pure cross sectional studies in 8-9 hours with majority of studies having findings and frequently complex. That is pretty much upper limits of what we can tolerate even with residents help, because we still have to review all the cases.
Good points…I’m in PP and call is about also about 80-100 cross-sectional but spread over 10-12 hours. Not sure what this amounts to in RVU’s but it is soul crushing at times, and burn-out is a lingering issue, as is the concern of a major miss/lawsuit. No way I’m doing this for a VA-type salary. The hospital would need to put on 2-3 rads for that type of salary which would end up costing more. I agree with what was said about limiting access/volume. If we did cut back there would be an immediate effect back-logging the ER/in-patients waiting for D/C, and putting the brakes on the HC system. As a specialty we need to leverage the essential role we play.-
Cool. If you agree the ACR should change tactics and focus on setting limits on radiologist rvus and work hours, then share with the ACR on this survey. This is the only way I can see preventing the further devaluation of our work and education.
On behalf of the American College of Radiology, I invite you to help us create a member experience thats right for you. Please take 10-15 minutes to Complete the Survey* and share your thoughts about the ACR
We want to understand what we are doing right and what could be better, the resources from the ACR that would be most helpful to you, and other topics of importance to the radiology profession.
Your feedback is important and will help us to better understand your needs as a member of the radiology profession and health care community.
Would you be so kind as to complete the survey before December 24th? Thank you for your feedback!
Click here to take the survey
Sincere regards,
Howard B. Fleishon, MD, MMM, FACR
Chair, Board of Chancellors
American College of Radiology-
Agreed, when most rads are hospital employed or by big corp, it makes a lot of sense for our society to put out guideline to limit the safe amount of studies read.
Lay people have no idea how fast some rad are going through their moms cancer staging study.
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I 100% agree with fumoney’s proposal also. There is no way to safely read more then about 60 RVU outpatient and 75 RVU inpatient in a 9 hour shift. And then groups couldn’t just increase RVU requirements anytime reimbursement drops from their rads and would actually require them to hire an adequate amount of radiologists for the workload. This proposal would do the most to better the life of radiologists and limit burn-out.
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AORN developed nurse staffing rules that mandate 2 nurses for X and staffing metrics. All accreditation societies check if you comply before issuing various licenses.
So in theory would be quite easy. Want an ACR license? No more than X rvus per rad.
Of course would prob usher in faster AI adoption..
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Quote from fumoney
Cool. If you agree the ACR should change tactics and focus on setting limits on radiologist rvus and work hours, then share with the ACR on this survey. This is the only way I can see preventing the further devaluation of our work and education.
On behalf of the American College of Radiology, I invite you to help us create a member experience thats right for you. Please take 10-15 minutes to Complete the Survey* and share your thoughts about the ACR
We want to understand what we are doing right and what could be better, the resources from the ACR that would be most helpful to you, and other topics of importance to the radiology profession.
Your feedback is important and will help us to better understand your needs as a member of the radiology profession and health care community.
Would you be so kind as to complete the survey before December 24th? Thank you for your feedback!
Click here to take the survey
Sincere regards,
Howard B. Fleishon, MD, MMM, FACR
Chair, Board of Chancellors
American College of Radiology
Filled that one out when I received it. Did heavily emphasize lackluster lobby/perpetual cuts/increasing volume etc
Will try to fill it out again or email him directly.-
I filled out today. Had to wait to the final question to share my ideas about rvu and hour limits. The more who share that idea the better!
As for speeding up AI adoption, perhaps I just am lacking in creativity, but I see AIlike every other techonological innovationmaking things more complicated, not simpler.
If rads have work limits, then the onus will shift from us to government to figure out how to keep things running smoothly. The government lacks the balls to limit access/overuse and we carry the weight of that burden which is bs. Some rads may argue that by reading less we would make less, but I would argue that the past 20 years prove that the more we read the more our contributions are devalued! And furthermore as we read more there is no empathy for our predicament. Lawyers, politicians just attribute our high volume of reading to our greed and dont acknowledge that we have no choice!
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I also filled out the survey today as you reminded me of it today and included the proposal to have an RVU limit on the last question so I seconded your response! And as docholliday126 stated this is actually not that hard to implement/mandate and most professional organizations have such safeguards in place (pilots, truck drivers, nurses, etc).
And if anything, AI is poised to make radiologists life much worse as they will be responsible to sign off on many more studies that have been “prelimed” by AI just increasing radiologists workload/liability greatly.
And as radiology gets more and more overutilized, the knee-jerk reaction is for the government to decrease reimbursement to keep salaries stagnant thus causing radiologists to work harder and harder to maintain the same salary. Instituting a workload-restriction will create a ceiling for the number of studies/radiologists and therefore as fumoney stated make the value of each radiologist much greater. Although this idea would have the greatest improvement on radiology, I am not hopeful enough higher ups in the radiology circle would have the courage or ambition to actually do anything beneficial such as this.-
I’ve thought about an RVU limit a lot and ultimately I think it’s one of those things that sounds great in theory but would be disastrous in practice.
– 75 wRVU reading outpatient msk MR in a small town is much different than 75 wRVU reading inpatient body/neuro MR at a tertiary academic center.
– 75 wRVU for radiologist A may be a lot but it may not be for radiologist B depending upon their speed, etc. Who decides the limits and how?
– Who picks up the extra studies that don’t get read? Radiologist shortage and quickest solution would be rapid adoption of midlevels/AI
– Highly unlikely pay per study would go up even if studies were limited, although they may plateau longer than they would otherwise
Most of us are definitely busy and likely reading too much but I think we have an internal safety gauge – or most of us do.
The major question is what problem are you actually trying to fix and I mean in detail what is that problem? It has to be thought through perfectly.
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Quote from Cubsfan10
I’ve thought about an RVU limit a lot and ultimately I think it’s one of those things that sounds great in theory but would be disastrous in practice.
– 75 wRVU reading outpatient msk MR in a small town is much different than 75 wRVU reading inpatient body/neuro MR at a tertiary academic center.
– 75 wRVU for radiologist A may be a lot but it may not be for radiologist B depending upon their speed, etc. Who decides the limits and how?
– Who picks up the extra studies that don’t get read? Radiologist shortage and quickest solution would be rapid adoption of midlevels/AI
– Highly unlikely pay per study would go up even if studies were limited, although they may plateau longer than they would otherwiseMost of us are definitely busy and likely reading too much but I think we have an internal safety gauge – or most of us do.
The major question is what problem are you actually trying to fix and I mean in detail what is that problem? It has to be thought through perfectly.
You make some good points. If/when we get a capitated system, guess we’ll get a sense of what’s a safe, reasonable pace (eg. will faster readers continue at their pace despite any financial incentive to do so?)
One thing we currently have on our side is that we are not replaceable or cannot get supplemented by mid-levels of AI yet. Who knows how long this lasts. Also I was thinking if this would be more of an ABR issue rather than ACR?
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AMA has a better lobbying arm than the ACR clearly. Redistribution of pay from rads to primary care and midlevel practitioners is what this is. Makes sense in a pandemic where the nation has been marked short of primary care practitioners. Unintended consequences of an insolvent medicare system. Thats why Im against a government run system! Gtfo of my livelihood with these voodoo metrics & payment schemes. You need a course of study just to understand how they derive these formulas! Shameful
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We may have to get creative.
People/the government pay(s) for things they think people want and have value. We need to show our value to the system to plateau the payment cuts.
One idea I have always thrown around is that we should be more forcibly putting out the idea that radiologists are providing “primary care.” I know it seems silly on its face because we are clearly specialized, however in a lot of cases these days with midlevels, rural settings, etc, the radiologist is the first physician a patient “sees.”
If the radiologist can be sued and can be labeled as the primary provider of patients they “see” when no other physician is involved (which is true), then we should be pushing that we are primary care for a lot of people and thus should gain the benefits of that in the public and government perception as well as payment models.-
Yes having a limit on the number of RVU’s a radiologist would dictate would make practices adapt, but just because it would require change, doesn’t mean that is a good enough reason not to do it. And yes, there is definitely a difference in RVU’s and workload, but since that is the system that has been accepted, that is the system that has to be used. Don’t get me started about the worthlessness of the RVU methodology, but since everyone has accepted it, it’s only fair that is what we use. And I would argue there is a relatively accepted number of RVU’s the majority of radiologists read in a 9 hour shift which would be equivalent to around 60-70 RVU’s. Just because a radiologist can dictate more then that, it doesn’t mean its safe/should be accepted. As I stated earlier, pilots/truckers/nurses have limits to their work, and I am sure some of them can do more safely, but the whole point is to eliminate mistakes due to fatigue/speed/carelessness for the majority of radiologists. And I also disagree most radiologists know their limits. In today’s environment, most radiologists are not in charge of their workload, and are forced to read more then they are comfortable/willing by upper management. How to deal with excess studies will put a focus on eliminating overutilization of radiology and valuing radiologists work. It will also delay/eliminate the annual salary decreases from Medicare. If physicians want to earn more, then can definitely work more shifts (which is a much safer way to earn more money) then working unsafe hours/workloads. I think the ABR and ACR should both be involved if they really want to improve the field of radiology for the future, but as we know, they sit in their Ivory Towers and don’t really address the real problems most radiologists (especially younger radiologists) face.
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Do these cuts affect technical and professional?
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