Data Driven

The Harvey L. Neiman Health Policy Institute® is shaping the future of radiology through evidence-based research.

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Abraham Lincoln once said, “The best way to predict your future is to create it.” In today’s dynamic era for radiologists, that is exactly what the Harvey L. Neiman Health Policy Institute® is striving to accomplish.

“This is a challenging time to be a radiologist,” says Richard Duszak Jr., MD, FACR, chief medical officer and senior research fellow at the Neiman Institute. “With ongoing budget cuts and an aggressive push to alternative payment models, no one can make a case for the value of radiology —and the metrics for measuring and communicating that value — as well as we can.”

Revealing the Rubric

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So what exactly is value? How do we measure it? And how should we incentivize it? Answering those questions is squarely in the wheelhouse of affiliate research fellow of the Neiman Institute Andrew B.  Rosenkrantz, MD, MPA, associate professor of radiology and urology at New York University School of Medicine.

Under the auspices of the Neiman Institute, Rosenkrantz is studying how well CMS value-based metrics for physicians have worked and where radiologists stand in the system. Based on his findings, he is creating a framework that ACR can propose to CMS and other payers to define value and assign measures to what radiologists do. “We looked at performance metrics used to evaluate radiologists,” he explains. “And we found that radiologists do well in specialty-specific measures, but not as well in generic measures applied broadly to all physicians. For a credible assessment of radiologists, we must develop more meaningful specialty-specific metrics.”

Rosenkrantz is also working to derive consistent formulas for evaluating general radiologists and subspecialists. “We’re examining radiologists’ actual service portfolios and billing records. Ultimately, we will have a rubric for relevant measures and payment incentives based on individuals’ practice patterns. This is unique compared with what has been done before. The resources and collaborative team at the Neiman Institute are vital to this research.”

Shifting the Paradigm

In the coming years, value-based changes will be imperative for radiologists to comply with health care reform initiatives under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The question every physician should be asking right now is, “What are my roles and responsibilities in those new payment models?” For radiologists, investigators at the Neiman Institute are working to define data that will provide the answers.

One of those investigators is Ezequiel Silva III, MD, FACR, chair of the ACR Commission on Economics. “The changes are so complex and they’re moving so quickly that they are dizzying,” he says. “To make sense of it, we’re working on a two-part, comprehensive review that walks radiologists through the history of alternative payment models and helps define our place in the next paradigm. Now radiologists will better understand the playing field we are on and how to prepare for the future.”

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Silva believes the research being done by the Neiman Institute will allow radiology to be more proactive in its approach to CMS, especially when it comes to defining payments under the merit-based incentive payment system (MIPS), a quality-based measurement program. “We want to go into the discussion with CMS empowered,” he says, “armed with hard data about the mechanisms under which we can contribute to long-term outcomes and population health.”

Creating the Future

Successful industries continuously reinvest in their future — including pharmaceutical companies and technology players such as Apple and Google. “The reason our specialty is successful is because of the innovators and investigators who have gone before us,” Duszak says. “They built a platform that will allow us to succeed. We must continue to make investments in our future through research funding that supports the radiology practice of tomorrow.”
Rosenkrantz agrees, emphasizing that radiology practices are directly impacted by what happens at the policy level. The actions of the federal government and other stakeholders must be based on credible research and accurate data. If not, we’re at risk. “It’s important for radiologists to realize that the work the Neiman Institute does has real policy implications, which can ultimately affect how we practice,” says Rosenkrantz.

Speaking to the importance of research in creating the future, Silva says, “The practice of radiology has seen tremendous gains over the span of our careers. We are in a time of transition now, where our practices for patient care are being studied with a level of scrutiny we should embrace. The only way we can validate what we do is to study it, and research requires funding. The ACR Foundation allows us to give back to our specialty some of the benefits we have achieved.”

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By Linda Sowers, freelance writer for ACR Press

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