Economics Forum: The Economy of Care

Patient-centered care was front and center at this year's economic forum.


Part two of Monday’s Economics Forum began with an awards ceremony. William T. Thorwarth Jr., MD, FACR, ACR’s chief executive officer, presented the Thorwarth Award for excellence in economic and health policy to Christopher G. Ullrich, MD, FACR. Thorwarth called Ullrich a “tremendous contributor” to the area of economic policy and to the specialty.

Thorwarth also presented a service award to Richard Duszak Jr., MD, FACR, for his eight years on the CPT Editorial Panel. And Bibb Allen Jr., MD, FACR, chair of the ACR Board of Chancellors, recognized Geraldine B. McGinty, MD, MBA, FACR, outgoing chair of the ACR Commission on Economics, with an award for her service on the Relative Value Scale Update Committee (RUC). “The reinvention of our specialty has been shepherded by Geraldine through her service on the RUC,” Allen noted.

PFCC Update

Following the awards ceremony, James V. Rawson, MD, P.L. J. Luther and Ada Warren Professor and chair of radiology and imaging at the Medical College of Georgia, led the economics talks by imploring radiologists to engage patients in the care process. “If we don’t talk to patients, we will be unsuccessful in our transition from volume to value,” said Rawson, who is also chair of the new ACR Commission on Patient- and Family-Centered Care (PFCC). As it is now, continued Rawson, “we have a physician-centric health care system, but patients and families need to be in the center. We need to work with them. If you don’t talk to the patient, you won’t know what they’re looking for.”

Knowing what patients want is important because patients are the drivers of health care spending, explained Rawson, who outlined several steps his hospital has taken to improve the patient experience. Rawson noted that the PFCC is working on tools and resources to help radiologists take action to make patients and families feel more comfortable and empowered in the health care setting.

The Importance of Medicaid

Raymond K. Tu, MD, MS, FACR, chief of staff at the Not-for-Profit Hospital Corporation and chair of the ACR Medicaid Network, also focused on patients during his presentation about the importance of Medicaid. Established in 1965, Medicaid provides health care coverage to people living in poverty. Medicaid and Medicare account for 40 percent of health care spending in the United States.

While Medicaid is sometimes considered a financial sink, Tu offered sobering statistics about who benefits from Medicaid, including 31 million children, nearly 4 million people with disabilities, and 11 million non-elderly adults who did not have health insurance prior to the Affordable Care Act, which expanded Medicaid coverage. In closing, Tu quoted Hubert Humphrey who said, “The moral test of government is how it treats those at the dawn of life, the children; at the twilight of life, the elderly; and in the shadows of life — the sick, the needy, and the handicapped.” Tu concluded: That’s why Medicaid is important.

Why Health Policy Matters

Duszak’s presentation moved the discussion toward health care policy. In his opening remarks, Duszak said, “We have entered into the era of evidence-based policy.” To move research from the laboratory to the bedside, radiologists need compelling evidence to convince the “beltway bureaucrats” to provide funding, he said. “Without good data, you’re just another constituent asking for money,” He said. Duszak noted several papers that have had a significant impact on the amount of money flowing into the specialty, including the one published in the New England Journal of Medicine in 2011 about reduced lung cancer mortality rates with low-dose CT. “This stuff costs a lot of money, but this is an investment in the future,” Duszak said. “Everybody that’s serving the ACR today, you’re paying it forward to the generation that will come after us.”

Radiology and Commercial Payers

The last speaker in the lineup, McGinty discussed engaging with commercial payers. She mentioned that imaging is not on the top of minds of insurance companies. “They seem to believe that radiology benefit management has fixed the problems around over utilization as they see it or imaging spending growth,” McGinty said. “They are quite happy with the service they are getting from the radiology benefit managers, which means that our approach with clinical decision support as a collaborative tool that reduces costs and improves care — that’s going to be a heavy lift to convince our insurance companies. But we’ve absolutely got to try.”

Payment Policies of the Future

Finally, McGinty gave a forecast looking ahead to 2020 and beyond, when Medicare Access and CHIP Reauthorization Act will be in full swing. “If I think about how we are going to be trying to influence the payment policy process in 2022, I don’t know that it’s going to look a whole lot different,” McGinty said. “I think you’re going to see us continuing to engage with the payment policy process as it is. We’re going to have to comb through every document, and we’re going to have to maintain that tireless attention to detail.” McGinty said she is confident about where the specialty will be in 2022. “It is in our DNA to learn from the best of the past to inform our future,” she said.

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