President Barrack Obama appended his signature to the bill of the Patient Protection Affordable Care Act of 2010 on March 23, 2010, making it a law. This law saw the extension of insurance coverage to more than 30 million American citizens. These health care reforms brought about changes to various sectors within the medical field including nuclear medicine. The changes trimmed the Medicare payment to the health plans and providers. In terms of nuclear medicine, the improvements significantly reduce the technical payments that were made for radiological examinations. With the reforms in place, it is an indication that they will have far-reaching consequences for organizations as they look forward to financing the radiological and imaging professional services. This might in the long run negatively affect the way nuclear medicine practice is offered in the radiological practice (Goldsmith, 2011). The reforms were able to ensure that the patient will have direct communication with the radiologist. Over the years, mots patients have wanted to have a direct contact with their radiologist, but it was not possible. The patients will now have the rare opportunity to have a chat with the physicians who are the most qualified to respond their questions about their imaging. Besides the reform allowing for the professional identities of the highly trained radiologist to be known to patients, the direct communication will also allow for a reduction in “Forgotten findings." The patients will have timely care given to them and the medico-legal liability of radiologist being reduced (Qayyum et al., 2013)
Health care reforms involve ensuring the quality of care and accessibility to the care by patients are optimum and on the same level. In the USA, millions of the citizens receive high-quality care services, and this is made possible by the country having the finest research centers, health care professionals, and academic health centers. Despite the USA having all these, the quality of care is far below what it is expected. This is what has led to the health sector in the USA being labeled as the worst among the most developed nations. Poor health care leads to increased, mortality rates and patients being sick, higher costs, increased disabilities and low confidence levels in the health care sector. Following all these challenges within the health care yet the country spends more than 18% of its annual GDP on health; it reveals that there is a need to improve the health care system as seen with the enforcement of the Patient Protection Affordable Care Act of 2010. Nuclear medicine is a medical specialty that allows for the diagnosis and treatment of diseases in a safe and painless way using radioactive substances. The radiology in nuclear medicine is referred to as "endo radiology" for it is done inside out. This means that the radiation being recorded is one that is emitting from inside the body and not that generated from external sources such as the X-rays. The health care reforms will have different impacts on nuclear medicine. With the changes shifting the health care sector from a fee-for-service reimbursement to an outcome-based one, professionals in nuclear medicine will have to adjust their roles when it comes to the care continuum. They will be forced to come up with better means to improve the value to the patient encounter and hospital systems and health care providers. Before the health reforms were enacted, the nuclear medicine professionals worked independently, but now, they have to collaborate with other physicians and non-physician practitioners (Mitchell and Bunning, 2013).
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In most businesses within the USA sector, the consumers play a significant role towards driving the business model. The businesses in return have to ensure the customer satisfaction is fully met. However, in the health sector, this has not always been the case whereby most patients have little confidence in the industry. As a result, the USA has seen increased mortality rates among its citizens, and all this is due to the poor quality of health care offered. However, with the introduction of the Affordable Care Act, this has come to change considerably. This Act has allowed people from the low and middle-income consumers to access medical services which were expensive before the Act (Krishnaraj et al., 2015). In nuclear medicine, most of the tests were expensive for a significant portion of the population, but they are now readily accessible. Medicare insurance will pay for these tests, implying that the imaging services will have to be performed by a certified professional by certification by the American Board of Radiology. Notably, radiology services account for at least 90 % the total amount of charges made under Medicare. The imaging services to be covered include; x-rays, CT scans, MRI scans and ultrasound. In the nuclear medicine diagnostic imaging and procedures, it covers the following, bone density scans, radiation oncology, radionuclides and Positron Emission Tomography (PET) for some conditions. The tests from nuclear medicine and molecular imaging are important to a patient. This is because they can provide unique information that can not be obtained by using other imaging procedures. The tests also allow the physicians to identify the diseases during their earliest stages of development. The procedures also employ the use of noninvasive methods that are painless and reduce the degree of injury on the patient.
The Affordable Care Organizations that was introduced by the Affordable Care Act of 2010 have been able to bring an alignment of health care cost and the quality of health care services. Following the existing fee-for-free service model introduced by the ACA 2010, it has reduced the expenditures that were linked to the imaging services using the assumed utilization rates and multiple procedure payment reductions. The expected imaging utilization rate determines the practice expense relative value units for "expensive" imaging equipment. A higher expected usage rate results in a lower technical component reimbursed through Medicare for each imaging study under such modalities. The assumed utilization rate in 1997 was at 50%v but has since been increased to 90% as the result of the American Taxpayer Relief Act of 2012.
The technical component of CT, MR CTA, MRI, and ultrasound performed on contiguous parts of the body as per the Multiple Procedure Payment Reduction (MPPR) introduced by the Centers for Medicare, and Medicaid Services (CMS) saw a 25% reduction in expenses in 2006.In 2011, the MPPR was increased in that the reimbursement reduction applied only on contiguous body parts scanned regardless of the important code family. The Affordable Care Act increased the MPPR of the technical component to 50% from the previous 25%.CMS also decreased the reimbursement for imaging procedures through the reduction of the professional component by 25% in 2012. CMS is still planning to reduce the cost of these tests in future (Qayyum et al., 2013)
The health reforms seen in the United States have had positive and negative impacts on nuclear medicine. With the reforms, they have brought about improved patient care and accessibility to the imaging servicers offered by nuclear medicine. The patients have also been given the opportunity to have a direct contact with their physician whom they can address questions regarding their imaging procedures. However, the reforms have also negatively affected nuclear medicine in that the changes significantly reduce the technical payments that were made for radiological examinations. This is going to influence the financing of the radiological and imaging professional services by the medical facilities.
In summary, before the enactment of the health care reforms Act, Affordable Care Act, 2010, by President Obama, a large part of the USA health care system was failing its citizens. This was despite the fact that the USA has one of the most sophisticated medical professionals, research facilities, and institutions. Nuclear medicine and molecular imaging, being part of the healthcare industry have also been affected by the reforms positively and negatively. Despite this, a huge percentage of American citizens can now access the services (Mitchell and Bunning, 2013).
References
Goldsmith, J. (2011). The future of radiology in the new health care paradigm: the Moreton Lecture. Journal of the American College of radiology , 8 (3), 159-163.
Krishnaraj, A., Norbash, A., Allen, B., Ellenbogen, P. H., Kazerooni, E. A., Thorwarth, W., & Weinreb, J. C. (2015). The Impact of the Patient Protection and Affordable Care Act on Radiology: Beyond Reimbursement. Journal of the American College of Radiology , 12 (1), 29-33.
Mitchell, K. R., & Bunning, S. K. (2013). Quality and value of nuclear medicine and molecular imaging: The impact of health-care reform. Journal of nuclear medicine technology , 41 (1), 3-8.
Qayyum, A., John-Paul, J. Y., Kansagra, A. P., von Fischer, N., Costa, D., Heller, M., ... & Itri, J. (2013). Academic radiology in the new health care delivery environment. Academic radiology , 20 (12), 1511-1520.
