A new analysis suggests medical imaging utilization will grow almost 14 percent if health reform survives the U.S. Supreme Court review this month, as tens of millions of new potential patients become consumers of health care. If current usage rates hold, the result will mean imaging centers across the country will perform half a billion additional scans over the next decade.

"What we're left with is, number one, as an industry, do we have the capacity to take on this additional utilization? And number two, how is it going to be paid for?" asked Brian Baker, president of Regents Health Resources, whose firm ran the analysis and developed the forecast.

Regents, a Franklin, Tenn.-based imaging services consulting firm, used 2010 exam numbers to create its projections for how the Affordable Care Act will cause imaging services to swell in the coming years.

According to Regent's math, imaging services will grow 13.6 percent nationally under health reform as nearly 37 million new patients are insured. That translates to about 456 million additional exams, based on 2010 procedure volumes.

HOW IT WAS DONE

Using Kaiser Foundation population data, Regents worked out there are 49.4 million truly uninsured people in this country. That is, they have neither private insurance, nor Medicare (available to the disabled and those over 65) nor Medicaid (for the poor).

However, uninsured doesn't mean uncared for, or that they're never seen by a doctor. Regents calculated that about a quarter of the uninsured are actually receiving health care, including imaging exams, in the form of uncompensated, charity or "no-pay" care, Baker said. That leaves about 37 million genuinely new patients who are not consumers in the health system now but could be under the Affordable Care Act.

Figuring out how many new patients the health system will absorb is only part of the puzzle. Use rates differ by age group. On average, for instance, people in their 40s and 50s (remember, all these new folks are under 65, otherwise they would be on Medicare) consume more health care than those in their 20s.

So to get the current predicted, post-ACA utilization rate, Baker said they broke down the 37 million new patients by age group and imaging modality, and then applied the known use rates to them. The result is the current figure, of about 13.6 percent growth.

CONSERVATIVE ESTIMATE

Baker believes his firm's estimate is low-balling the true need for imaging services over the coming years, as it doesn't take into account population growth, nor the growth of the over 65 population, which he said uses imaging services at six times the rate of younger patients.

According to the World Bank, U.S. population grew 0.8 percent in 2010. And Baker said the 65 and up cohort grows about 2 percent a year.

"That 13.6 percent doesn't factor in those two elements," he said. "We consider it to be conservative."

STATE BY STATE

Not all states will face the changes equally. Some, like Massachusetts, Minnesota and Hawaii, already have comprehensive health programs, and as a result, most of their residents are insured. Baker said their predictions show that in Massachusetts, imaging services will grow a manageable 4 percent.


"Just by increasing service hours, it's probably at a level where (imaging providers) can handle it," he said.

But imaging centers in other states will have more work to do. Texas, California and Georgia, for instance, all have large uninsured populations. Thus, for Texas, CT and MRI services, together, could grow nearly 25 percent statewide, according to Regent's forecast. This could put a strain on Lone Star providers, especially as many work with older, lower-throughput equipment, he said.

"Texas and California are going to have a tough time," he said.

FATE OF HEALTH REFORM

Baker said it's hard to say how easily imaging centers could absorb the new patients.

Of course, they'd likely have to buy new equipment or hire new staff. But he said his team is still crunching the numbers to develop the projections for new equipment purchases and radiologist and radiologic tech hiring. Nonetheless, he expects it will be "good news" for medical imaging OEMs.

But some things are harder to figure out at the moment, such as what the reimbursement level will be for providers on some of these new insurance plans - will service payments be closer to Medicare, for instance, or Medicaid?

It's also possible that in a few weeks, this whole conversation will be moot.

Last month, the U.S. Supreme Court heard oral arguments over the constitutionality of health reform, and some analysts think the conservative majority on the bench appeared to be in favor of striking down the law, or at least its centerpiece, the individual mandate. What happens then?

"All these forecasts go away," Baker said.

Baker is confident many elements of reform will survive, but his confidence is certainly not shared by everyone. For what it's worth, as of Wednesday afternoon, bettors on the online prediction market Intrade favored a nearly 71 percent chance that the U.S. Supreme Court will overturn the individual mandate this year, with pro-overturning shares trading at $7.12.