Quality and value of nuclear medicine and molecular imaging: the impact of health-care reform.

On the heels of one of the most contentious, divisive general elections in recent history, one topic will remain front and center: our nation’s health care. Political pundits and prominent health-care experts concur that health-care reform is here to stay. As we enter into its third year of implementation, a salient question remains: What does health reform mean for nuclear medicine and molecular imaging? The objectives of this article are, first, to present a background of key provisions of the Affordable Care Act and its relevance to nuclear medicine and molecular imaging; second, to highlight specific challenges in defining and measuring quality in the field; and third, to outline future trends that will be anticipated in the coming year. Inefficiencies in our health-care delivery system and market failures have fueled demands for change. Healthcare expenditures in the United States are currently about 18% of the gross domestic product and have been projected to rise sharply over the next several years (1). Despite these expenditures, the United States is lagging behind other industrial nations across multiple key indicators of quality (2), including 5-y survival rates for breast cancer and rates of lower-extremity amputations due to diabetes (3). These observations have led to the need for health reform. At the same time, in the era of governmental deficit reduction, employers facing rising health-care costs and an uncertain market have caused the cost of care to shift toward patients. The health-care reform law enacted in March 2010 is known by many names: the Patient Protection and Affordable Care Act, the Affordable Care Act, or sometimes Obamacare. Because the first name, Patient Protection and Affordable Care Act, was considered too long, it was shortened to Affordable Care Act (ACA) when the law was amended. The ACA resulted in the most sweeping changes to health-care coverage, financing, organization, and delivery of services since the creation of Medicare and Medicaid programs during President Johnson’s Great Society, an era in the 1960s characterized by greater emphasis on public health. The cornerstone of current health reform is an emphasis on improving quality, efficiency, and patient experience through achieving 3 main goals: coverage and insurance market reform, financial strategies for health reform, and delivery and payment system reform. Almost everyone recognizes the more famous portions of the ACA that focus on coverage and insurance market reform: the individual-insurance mandate, individuals up to 26 y old qualifying for their parents’ insurance coverage, the health-care exchanges, and the ban on annual and lifetime limits. Although financial strategies are foundational to health reform, ACA has signaled incremental, not fundamental, changes to payment strategies by first seeking to demonstrate innovative payment models. Public and private payers are experimenting with a variety of payment reform approaches from bundled payments to global payments, integrating quality measurement and reporting into the payment system. Such financial reform models are highlighted in Table 1.