Socioeconomic J. Hillman,
Bruce Robert
#{149} Lee
B. Bernhardt,
BA
#{149} William
of a
tion
of that
panel discussion conducted as a Special Focus Session at the 77th Scientific Assembly and Annual Meeting of the Radiological Society of North America. The topic of discussion was “the new health care,” embodying the regulatory, reimbursement, and organizational structure of medicine, how these important influences are currently in flux, and how they might affect the practice of radiology.
you
live
During
presents
the past
the
details
decade,
and
most
certainly in the years to come, cians will be experiencing the
terms:
Economics,
and radiologists, Radiology
MD
#{149} Ronald
B. Schilling,
PhD
RSNA Special Focus Session on New Health Care”: Impact on Radiologists’
HIS article
Index
Y. Rial,
W. Vanderlish
1991 “The
T
MD
Issues
medical
socioeconomic
physirealiza-
.
Radiology
issues
1992; 184:309-314
panelist
ageless
of the Department
curse, “may The changes in health care have been dramatic. Assessing the complexity of these changes and how they may affect radiologic practice in the future is the challenge addressed by the panelists. Each in
Yiddish
interesting
times.”
represented
a different
point
of
view: technology manufacturer, radiologist, payer, and benefits management. Each discussed how the health care environment may affect radiologists from his own perspective. The panelists included the following: Ronald B. Schilling, PhD, senior vice president and general manager of Toshiba America Medical Systems, who has over 30 years of experience in high technology research and development, marketing, and management; Bruce J. Hiliman, MD, professor and chairman
of Radiology
at the
University of Virginia and senior scholar at the University of Virginia Center for Health Policy Research; William Y. Rial, MD, past president of the American Medical Association, a former member of the Joint Commission on Accreditation of Hospitals, and now di-
rector
of Provider
Relations,
the Blue
Cross and Blue Shield Association; and Lee B. Bernhardt, BA, director of operations for the United Mine Workers of America Health and Retirement Funds, who manages the health care benefits of retirees and their dependents for one of America’s most prominent unions.
Abbreviations: groups, HMO tion.
=
DRGs
=
health
maintenance
diagnosis-related
organiza-
‘ From the Department of Radiology, University of Virginia, Health Sciences Center, Box 170, Charlottesville, VA 22908 (B.J.H.); United Mine Workers of America Health and Retirement Funds, Washington, DC (L.B.B.); Blue Cross and Blue Shield Association, Chicago (W.Y.R.); and Toshiba America Medical Systems, Tustin, Calif (R.B.S., R.W.V.). From the 1991 RSNA scientific assembly. Received February 6, 1992; revision requested February 28; revision received March 18 and accepted March 18. Address reprint requests to B.J.H. © RSNA, 1992
Ronald
B. Schilling,
PhD
#{149} Robert
Manufacturers Manufacturers must predicate
future curred During
undergone practice,
of Radiologic
of radiologic their current
technology views and
plans on what has recently ocin the health care environment. the
past
25 years,
W. Vanderlish
medicine
a transition from to being a business,
has
being a to being an
industry. This has evoked efforts from payers, especially the federal government, to contain the rising costs associated with this transition. As the number of Medicare beneficiaries grew in the 1970s, hospital charges increased with the traditional, retrospective, cost-plus system. This prompted the implementation of a prospective payment system that was based on diagnosis-related
Technology
groups From change
(DRGs). the federal perspective, from a retrospective
system
to a prospective
system
the payment made
the growth of Medicare part A actuarially predictable. However, DRGs contributed to the emphasis on switching from inpatient to outpatient health care. As evidenced, this change bolstered the growth of Medicare part B services and
made
them
more
unpredictable.
Prospective payment drove hospital operating margins down dramatically. Hospitals transferred the shortfall to private paying patients (cost shifting). Health insurance costs increased sharply,
followed
by
insurance
compa-
nies raising rates and buyers, especially businesses, crying foul. Because business had a need to control health care costs, business raised employee premiums, increased deductibles, and offered
preferred health
(HMO)
provider maintenance
organization
and
organization
plans.
HMOs became a successful alternative to fee-for-service medicine, and large numbers of patients began to enroll. This enabled them to contract with hospitals from a position of strength-
hospitals
needed
patients.
Hospitals
were breaking new ground by contracting with HMOs on a discounted per diem basis. However, many hospitals
309
Bruce Robert
#{149} Lee
B. Bernhardt,
BA
#{149} William
of a
tion
of that
panel discussion conducted as a Special Focus Session at the 77th Scientific Assembly and Annual Meeting of the Radiological Society of North America. The topic of discussion was “the new health care,” embodying the regulatory, reimbursement, and organizational structure of medicine, how these important influences are currently in flux, and how they might affect the practice of radiology.
you
live
During
presents
the past
the
details
decade,
and
most
certainly in the years to come, cians will be experiencing the
terms:
Economics,
and radiologists, Radiology
MD
#{149} Ronald
B. Schilling,
PhD
RSNA Special Focus Session on New Health Care”: Impact on Radiologists’
HIS article
Index
Y. Rial,
W. Vanderlish
1991 “The
T
MD
Issues
medical
socioeconomic
physirealiza-
.
Radiology
issues
1992; 184:309-314
panelist
ageless
of the Department
curse, “may The changes in health care have been dramatic. Assessing the complexity of these changes and how they may affect radiologic practice in the future is the challenge addressed by the panelists. Each in
Yiddish
interesting
times.”
represented
a different
point
of
view: technology manufacturer, radiologist, payer, and benefits management. Each discussed how the health care environment may affect radiologists from his own perspective. The panelists included the following: Ronald B. Schilling, PhD, senior vice president and general manager of Toshiba America Medical Systems, who has over 30 years of experience in high technology research and development, marketing, and management; Bruce J. Hiliman, MD, professor and chairman
of Radiology
at the
University of Virginia and senior scholar at the University of Virginia Center for Health Policy Research; William Y. Rial, MD, past president of the American Medical Association, a former member of the Joint Commission on Accreditation of Hospitals, and now di-
rector
of Provider
Relations,
the Blue
Cross and Blue Shield Association; and Lee B. Bernhardt, BA, director of operations for the United Mine Workers of America Health and Retirement Funds, who manages the health care benefits of retirees and their dependents for one of America’s most prominent unions.
Abbreviations: groups, HMO tion.
=
DRGs
=
health
maintenance
diagnosis-related
organiza-
‘ From the Department of Radiology, University of Virginia, Health Sciences Center, Box 170, Charlottesville, VA 22908 (B.J.H.); United Mine Workers of America Health and Retirement Funds, Washington, DC (L.B.B.); Blue Cross and Blue Shield Association, Chicago (W.Y.R.); and Toshiba America Medical Systems, Tustin, Calif (R.B.S., R.W.V.). From the 1991 RSNA scientific assembly. Received February 6, 1992; revision requested February 28; revision received March 18 and accepted March 18. Address reprint requests to B.J.H. © RSNA, 1992
Ronald
B. Schilling,
PhD
#{149} Robert
Manufacturers Manufacturers must predicate
future curred During
undergone practice,
of Radiologic
of radiologic their current
technology views and
plans on what has recently ocin the health care environment. the
past
25 years,
W. Vanderlish
medicine
a transition from to being a business,
has
being a to being an
industry. This has evoked efforts from payers, especially the federal government, to contain the rising costs associated with this transition. As the number of Medicare beneficiaries grew in the 1970s, hospital charges increased with the traditional, retrospective, cost-plus system. This prompted the implementation of a prospective payment system that was based on diagnosis-related
Technology
groups From change
(DRGs). the federal perspective, from a retrospective
system
to a prospective
system
the payment made
the growth of Medicare part A actuarially predictable. However, DRGs contributed to the emphasis on switching from inpatient to outpatient health care. As evidenced, this change bolstered the growth of Medicare part B services and
made
them
more
unpredictable.
Prospective payment drove hospital operating margins down dramatically. Hospitals transferred the shortfall to private paying patients (cost shifting). Health insurance costs increased sharply,
followed
by
insurance
compa-
nies raising rates and buyers, especially businesses, crying foul. Because business had a need to control health care costs, business raised employee premiums, increased deductibles, and offered
preferred health
(HMO)
provider maintenance
organization
and
organization
plans.
HMOs became a successful alternative to fee-for-service medicine, and large numbers of patients began to enroll. This enabled them to contract with hospitals from a position of strength-
hospitals
needed
patients.
Hospitals
were breaking new ground by contracting with HMOs on a discounted per diem basis. However, many hospitals
309
