In Case You Missed It
ACR 2017: Monday, May, 22
ACR 2017 has begun! Here are the goings-on from day two of the conference.
Andrew B. Rosenkrantz, MD, ACR Young Physician Section (YPS) chair, kicked off the proceedings by describing the members who comprise this singular section. According to Rosenkrantz, ACR members under the age of 40 or within eight years of completion of training are eligible to join. The section includes more than 6,600 members, 16 percent of whom are ACR members and 25 percent of whom are dues-paying members.
True to its mission of amplifying the voice of young and early-career physicians, the YPS has achieved representation on 90 percent of ACR commissions, committees, subcommittees, and task forces. In addition, all state chapters have offered support for an additional alternate councilor slot earmarked for a YPS member.
Of particular interest to the section is exerting influence in the legislative arena. To this end, 421 section members participated in this past year’s RADTOBERFEST, a fundraising initiative similar to March Madness in which state chapters compete against each other to raise campaign donations to RADPAC. This total is up from just 186 section members two years ago and comprised 20 percent of overall contributors to RADPAC.
In addition to its involvement with College commissions and fundraising initiatives, the YPS also makes its presence felt via the written word. The section’s Twitter account has attracted over 900 followers, section members have established a strong presence on the internal discussion forum Engage, and leadership keeps members apprised of new developments via a regular newsletter. On top of this, members recently published a well-received JACR® article on the topic of women in radiology.
The session closed with discussion of goals for the coming year. Top of their list is improving retention of members transitioning from RFS to YPS status, along with increasing the diversity of the section.
Case in point was the number of RFS members attending this year’s annual meeting: 455, up from 380 just two years ago. Extending the Millennial metaphor, Glover characterized the RFS as having “evolved from a growth phase to maturation.” Signs of this maturation include the inclusion of resident- and fellow-oriented topics at ACR 2017 that explored career pathways, how to get involved in ACR governance, and ways to become a leader.
Of particular importance to the section is diversity and gender equality. One major initiative moving the dial in these important areas is the RFS Women and General Diversity Advisory Group. Led by outgoing chair Amy K. Patel, MD, and incoming chair Michele V. Retrouvey, MD — and including many other RFS members — this advisory group works with ACR’s Commission for Women and Diversity to identify effective recruitment strategies in an effort to attract women and minorities to the field. One product of the advisory group’s work was a recent ACR Bulletin blog post by Patel titled “Shattering Radiology’s Glass Ceiling,” which is one of the most-viewed posts in the blog’s history.
A multitude of payment challenges facing radiologists — from the value of fee for service to the complexities of future payment models — were elucidated and debunked at the two-part 2017 Economics Forum. Moderated by Ezequiel Silva, MD, FACR, chair of the Commission on Economics, the session highlighted the ACR’s efforts to ensure the economic viability of the field of radiology.
To emphasize the impact that improved and widespread breast imaging has made on women’s mortality rates, Silva introduced Dana H. Smetherman, MD, FACR, vice chair of the department of radiology and head of breast imaging at the Ochsner Health System in New Orleans. She expressed concerns over the somewhat slow adoption of coverage for digital breast tomosynthesis (DBT), despite its impressive life-saving detection rates. Pointing out that tens of thousands of lives would not be saved without annual screening mammograms, she noted that (under the proposed American Health Care Act) states may soon be allowed to determine which essential benefits (including preventive services such as screening mammography) health plans are mandated to provide. Obstacles to DBT reimbursement because of technical component (TC) codes require a call for action, she said, to significantly reduce costs and protect the lives of millions of women. She urged the audience to “rise up and defend access to mammography.”
Kurt A. Schoppe, MD, chair of the ACR Reimbursement and Practice Expense Committee, joined the forum to discuss finding the real value in fee for service. He showcased the efforts of the RVS Update Committee (RUC), which helps shape the resources needed to provide the physician services that CMS considers when developing relative value units (RVUs). “It’s a medical fight club,” he joked.
The work that goes into certain screenings, he said, is not accurately reflected right now in the RVUs. “We need to be able to show all of the work we do beyond the interpretation of images.” That includes coordination with other specialties, managing patient relationships, and communicating with patients using all data available. The real value in fee for service, Schoppe said, comes from the values of radiologists and the compassion they show to patients. Fee for service is fundamental, he added, to bundling payments and to alternative payment models — because the business of medicine is changing and the science of medicine is evolving. “Our reputation as a specialty will affect reimbursement,” he said, “and your values are much bigger than your RVUs.”
Rounding out the discussion was Gregory N. Nicola, MD, chair of the ACR Medicare Access and CHIP Reauthorization Act (MACRA) Committee, who told the audience he understood how daunting the implications for radiologists could be with future payment models under MACRA. “The measurement of how we perform has already started, and how you have scored under this program is going to be public information,” he said. He explained that within Medicare there is the Quality Payment Program (QPP), and within the QPP are the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). “MIPS is meant to be uncomfortable,” he said. “It’s somewhere you don’t want to stay.” There are incentives to get into an APS. The ACR, its staff, and the MACRA team have simplified the terminology under MACRA, he noted. “We’ve slowed down the process and empowered members with registries and digital content,” he said. Nicola urged the audience to join the conversation about quality measures and payment models on platforms like Engage. “There are roughly 35 people working on legislation at any one time in the ACR,” he said, “but 35,000 minds are better.”
The connection between economics and patient-centered care is not always emphasized, but the second half of Monday’s Economics Forum linked the two.
It started with the presentation of the Thorwarth Award for excellence in economics and health policy to James V. Rawson, MD, FACR, for his service to the College, spanning from his time as a leader in navigating the Hospital Outpatient Perspective Payment System (HOPPS) more than a decade ago through to his current position as chair of the Commission on Patient- and Family-Centered Care.
Upon receiving the award, Rawson reflected on the relationships he’s formed through the ACR and at his own institution over the years. He noted that ACR 2017 attendees included not only his students, residents, faculty, and alumni but also some of his patients. “The ACR has been just an amazing journey through HOPPS [and] through the Patient- and Family-Centered Care Commission,” Rawson said.
Following the award presentation, Ezequiel Silva III, MD, FACR, chair of the Commission on Economics and forum moderator, introduced Keith J. Dreyer, DO, PhD, FACR, chair of the Commission on Informatics, to deliver the forum’s keynote address about artificial intelligence (AI). In doing so, Silva reminded everyone that informatics tools will be increasingly critical to radiology’s economic success.
Dreyer explained that AI uses sensory data and algorithms to simulate the functionality of the human brain — enabling computers to “see” objects and learn over time. Recently, the technology has advanced such that computers can recognize objects better than humans, leading to some speculation that machines could eventually supplant radiologists.
But Dreyer said that narrative is all wrong. AI is a powerful tool that radiologists will harness to deliver additional information to referring providers for improved outcomes and enhanced patient care. “This will provide more value to us and more value to our patients,” said Dreyer. “I see this as a very bright addition into what it is that we do.”
To ensure radiologists drive the integration of AI into practice, the College recently formed the Data Science Institute. Dreyer said the new institute will set standards, test and evaluate algorithms, and address the ethical, legal, and regulatory issues associated with AI in imaging.
The conversation then pivoted to health insurance. Mark O. Bernardy, MD, FACR, vice chair of the Commission on Economics, discussed the evolution of health insurance under the Affordable Care Act (ACA) and the proposed American Health Care Act (AHCA) currently in Congress.
Bernardy described the impact of the ACA, noting that while more people gained coverage and medical inflation decreased under the law, health insurance premiums ballooned, deductibles increased, and some insurance companies pulled out of the exchanges. One reason for this was that some young and healthy people did not purchase insurance, despite the mandates, Bernardy said.
Now, the U.S. House of Representatives has approved the AHCA, which, among other things, repeals the ACA coverage mandate and other associated taxes, gives states block grants for Medicaid, and allows insurance companies to charge older people more for coverage.
While the AHCA is likely to undergo significant changes in the Senate, Bernardy said coverage decisions will likely still shift to the states, and he called on radiologists to get involved in the process. “Health care reform is coming to a state near you,” he said. “This is your opportunity to change the system, improve health care, and help your patients, neighbors, friends, family, and yourself.”
To close the forum, Sanjay K. Shetty, MD, MBA, delivered a presentation about accountable care organizations (ACOs) — a delivery model that he expects to flourish.
In ACOs, providers contract to operate under a simple equation: Budget – Expenses = Surplus (reward) or Deficit (penalty). “You’re on the hook for an entire population of patients,” he said. “The goal of accountable care is to deliver the right care, at the right place, at the right time.”
Shetty suggested that a tipping point is coming in which more stakeholders, particularly large companies, are increasingly interested in ACOs. As this happens, more ACOs are expected to form. Already, more than 570 ACOs exist across the country. In fact, Shetty said, many radiologists may be in a value-based contract and may not even realize it. He implored radiologists to find out the status of their contracts and make sure they have a voice in managing these agreements. “Radiologists have to be at that table to make sure that our value is recognized,” he said.