What’s Next for the Commission on Economics

The College is charting a course for success in a changing world of reimbursement and incentives.

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This is my first column as incoming chair of the ACR Commission on Economics.

Under the exceptional leadership of former Chair Geraldine B. McGinty, MD, MBA, FACR, the commission is as strong as it has ever been. We have an effective organizational structure with dedicated leaders, volunteers, and staff at every level. The commission has a significant responsibility, since our members consistently rank economics and advocacy among the most important roles of the ACR. The economic climate surrounding radiology is evolving quickly, and the commission must adapt to meet these new challenges. As I begin my term as chair, I’ve set forth five guiding principles for the Commission on Economics.

We Will Protect Fee for Service.

The majority of physicians currently operate under fee for service (FFS), in which providers are paid a set amount for each procedure completed. We will continue to protect this system going forward. FFS will remain an important source of revenue for most of our practices for the foreseeable future. Every pay-for-performance program (including new systems tied to quality, such as the Merit-Based Incentive Payment, or MIPS), has FFS as the base payment to which adjustments are applied. Plus, almost every future payment model involves FFS at some level. In addition, most individual radiologist performance metrics, either within radiology or across multi-specialty groups, are based on per-unit FFS amounts. Frankly, it would be imprudent to help our members garner a bonus of around 9 percent under MIPS only to allow equal or greater reductions in the FFS payments to which the bonus is applied.

We Will Secure Radiology’s Place in Future Payment Systems.

We must acknowledge the shortcomings of FFS, and we cannot assume that FFS will support radiology indefinitely. The 2015 passage of the Medicare Access and CHIP Reauthorization Act (MACRA) solidifies Medicare’s commitment to a shift from volume-driven payments (such as FFS) to value-driven payments (such as MIPs). The private payer community will likely follow.

But MACRA provides only a general blueprint for this change. The details will be defined through rules and regulations created over the next few years. These regulations will affect radiology payments and impact radiology’s broader role in health care for the next decade and beyond. The Commission on Economics will achieve expertise in new payment paradigms, and we will guide policymakers on the role that radiology stands to play in the future of health care.

We Will Collaborate.

We have a strong fund of knowledge in the Commission on Economics to inform future payment model discussions. However, that knowledge is not enough. Future payment models are complex and mandate coordination and cooperation among multiple stakeholders. This will require collaboration between economics and others with complementary expertise. Within the ACR, we will partner with its other commissions, such as Informatics, Quality & Safety, Education, and Patient- and Family-Centered Care. Outside the ACR, we will engage radiology subspecialty societies, nonradiology specialties, and nonphysician organizations, including the vendor community.

We Will Engage Patients.

What we do in the Commission on Economics is always based on what is best for patients. This commitment will broaden. MACRA makes it clear that physicians will be judged on patient experience. Patients will become more important participants in their care and will assume greater financial responsibility for that care. We must embrace this trend. The new ACR Commission on Patient- and Family-Centered Care will be a valuable source of information and guidance in this regard.

We Will Represent Our Entire Membership.

Radiologists practice in varied settings, such as private practice, academia, multi-specialty groups, and teleradiology. The commission will include representation from all practice types, regions of the country, and stages of career. The ACR represents all radiologists, and the commission will do the same.

Radiology finds itself amidst an important transition period. The Commission on Economics stands ready to meet the challenges and pursue the opportunities before us. We will protect existing payment systems, embrace new ones, and ensure collaboration, diversity, and patient engagement along the way. As the new chair of the Commission on Economics, I embrace the challenge of leading this effort.


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 Ezequiel Silva III, MD, FACR, Chair of the Commission on Economics

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