Patience and Patient Relationship Codes

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The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 instructs the Centers for Medicare and Medicaid Services (CMS) to include a category in the Merit-based Incentive Payment System (MIPS) that holds physicians accountable for costs.

MACRA further prescribes one of the measurements of costs be through episode-base cost measures and that attribution of these episodes maybe facilitated by patient relationship categories and codes. Eight episode-based cost measures have been developed and field tested, but these measures were not finalized by CMS and therefore will not contribute to the measurement of the Cost category in MIPS for 2018. In the meantime, CMS is mandated to implement the patient relationship categories and codes for 2018 and is allowing voluntary reporting of them for this year by way of newly developed modifiers.

Patient relationship category modifiers can be used in a variety of settings, but they are primarily

intended for use in episode-based cost measures. It is unclear how physician practices can use these modifiers without any finalized episodes to which they would be appended. The ACR has made public comments on the finalized patient relationship modifiers, although the comments did not significantly alter the code structure. CMS says that they will issue guidance on use of the modifiers, but nothing has been published to date. Also, CMS has provided few details on how each of the finalized patient relationship codes would be used to attribute patients and allocate costs to reporting clinicians. Given all the uncertainties surrounding the use and implications of these new modifiers, the ACR, AHRA, and RBMA jointly had no recommendations on how to append these codes in 2018.




Patient Relationship Categories


Continuous/broad services


Continuous/focused services


Episodic/broad services


Episodic/focused services


Only as ordered by another clinician


Eight ACR representatives participate on CMS subcommittees that are working on episode-base measures. This work is vital in establishing the role of imaging within episodes and how radiologists can most appropriately be held accountable for costs. It is important that we carefully evaluate the benefits and potential consequences of all reporting tools and guidelines as the transition to value-based care evolves. Sometimes “watchful waiting” even applies to radiologists.

 Pam Head Shot By Pamela Kassing, MPA, Senior Economics Advisor in the ACR Department of Economics and Health Policy

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