Our Responsibility to the Economic Stability of Our Patients

ACR-18Ezequiel Silva III, MD, FACR, chair of the American College of Radiology Commission on Economics, contributed this post.

The Hippocratic Oath, taken by most graduating medical students, includes the following: “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” Indeed, medicine is an art and it is a science. These principles should always be the focus of our medical education and residency training.

But there is another statement in the Hippocratic Oath that is less often discussed but equally important: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

According to the oath, economics has a role in complementing the art and science of medicine. We have a responsibility to this pledge, which makes us better physicians. Understanding health care economics allows us to talk to our patients about their insurance coverage and to reassure them at a vulnerable time in their lives. It is also protective. We are surrounded by non-physicians who work in health care and influence decisions affecting patient care. As physicians, we are the only ones who took the Hippocratic Oath and we are the ones tasked with preserving the physician-patient relationship. We have the credibility, and the responsibility, to speak for our profession and for our patients. This includes economics.

To its credit, the Accreditation Council for Graduate Medical Education (ACGME) acknowledges the importance of economics during residency. In 2012, the ACGME and the American Board of Radiology (ABR) collaborated on the creation of the radiology milestones program and crafted milestones specific to health care economics. Radiology residents are required to satisfy these milestones in order to graduate from residency. The ACR Radiology Leadership Institute (RLI), being a leader in educational content and having the depth of the ACR’s economics experts readily available, was an obvious choice to lead in this effort.

The ACR RLI’s Health Care Economics Milestones Program has been in place for more than four years. And last year, it included 21 residency programs, including programs such as Massachusetts General Hospital, Virginia Mason, Indiana University, and Albert Einstein Medical Center. I have the privilege of serving as faculty for one of the five sessions of the program. Our content is not only robust, but also recognizes that our trainees are busy learning the science I previously mentioned. Therefore, our health care economics milestones are taught in an efficient and effective manner. For example, our program includes limited didactics, enough to allow for an active data exercise with experience and conclusions shared with other participating programs. This encourages rich discussions, pertinent conclusions and new directions for exploration. More importantly, for those willing to take their study to another level, our program enables career leadership opportunities.

We would love to have more programs involved, and your residents will come away better prepared to navigate a rapidly changing radiology health care landscape and add value for their patients and institutions. For more information, please visit www.acr.org/hcem.

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To Defeat a ‘Politically Incorrect’ Cancer, We Must Also Address Unequal Reimbursement

Dr.McGinty(updated)_andcroppedGeraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors, contributed this post.

The American College of Radiology (ACR) has been focused on advocating for policies to expand access to low dose computed tomography (CT) screenings for early detection of lung cancer for many years.

Lung cancer claims over 140,000 lives per year in the US, more than the next three leading types of cancer combined. CT lung cancer screenings are the first and only cost-effective test proven to greatly reduce lung cancer deaths. That’s why we were excited to see former New York Lieutenant Governor Betsy McCaughey’s recent article, “Hope for defeating a ‘politically incorrect’ cancer,” where she argues the stigma around lung cancer is beginning to subside and getting tested is becoming more routine. However, as it went unmentioned, she may have been unaware that a major barrier to getting this care is the unequal reimbursement rates for CT lung cancer screening exams.

Medicare undervalues CT lung cancer screenings and treats them differently than similar types of scans. Shortly after Medicare began covering lung cancer tests in 2016, it cut the reimbursement to approximately $60 per exam, less than half of what it pays for a mammogram. This only continues to reinforce Ms. McCaughey’s argument that lung cancer is a disease to be ashamed of, discouraging prevention and treatment.

As we are all well aware, paying less for a procedure directly harms patients. If hospitals and outpatient facilities cannot afford to provide these tests, it greatly restricts the number of places patients can receive lung cancer screenings. We know that this preventative procedure has the potential to save 65,000 American lives each year. That number will never be realized if barriers remain that restrict access to these screenings.

I applaud former Lieutenant Governor McCaughey for highlighting the disparities between how the United States perceives and treats lung cancer compared to other cancers. Yet, we must remember that we need proper coverage so our patients who need these screenings the most can access them. ACR will continue to advocate for Centers for Medicare and Medicaid Services to increase the reimbursement rate for CT lung cancer screenings, thereby expanding public access to the procedure.

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TMIST: Attacking Breast Cancer in Three Dimensions

Etta Pisano 16May17_0002 headshotEtta Pisano, MD, FACR, principal investigator of the Tomosynthesis Mammographic Imaging Screening Trial contributed this post.

I wanted to thank the breast imaging community for the tremendous response that the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) has recently received.

The number of patients enrolled in TMIST has doubled in recent months. New facilities are coming on board every week. Sessions at the 2019 Society of Breast Imaging (SBI)/American College of Radiology (ACR) Breast Imaging Symposium and other recent meetings have drawn tremendous interest.

On June 20, the National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH) will present “TMIST: A Three-Dimensional Approach to Early Breast Cancer Detection,” the next installment in the “Women’s Health Seminar Series.”*

Interest continues to grow as more radiologists find out about the trial, what we are trying to do and how taking part in TMIST can strengthen your practice, expand screening access to the uninsured and shape future breast cancer screening.

Nearly 70 sites throughout North America are already taking part. We would like to add many more in the coming months.

I invite you to visit acr.org/TMIST  to get more information on how your practice can take part in the largest randomized controlled breast cancer screening trial in decades.

You can also email TMIST@acr.org with any questions you may have about TMIST.

We hope to hear from you soon.

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*Continuing Medical Education (CME) credits are available for this NIH seminar.