Forward Momentumforward momentum

The fall meeting of the ACR Board of Chancellors was held Oct. 17-20, 2011 and was attended by the Council Steering Committee (CSC). Initial presentations by the chairman, president, CEO, and treasurer updated the board on progress made since May.


I reported that I had the opportunity to represent the ACR at several meetings of other national and international societies, and I am pleased to report that the ACR has become a central and respected force in the international community. We will collaborate with the European Society of Radiology in a worldwide awareness campaign in November 2012 and will create an annual international summit on radiological quality and safety in Washington, D.C., in conjunction with the International Society of Radiology — also in 2012.

A new Task Force on Medical School Radiology Education has been implemented and charged to present an ACR White Paper in April 2012. The task force will develop a database on the current status of radiology education in medical schools; identify common elements among medical schools, levels of participation of radiology faculty, current teaching goals, and methodology; and, will create a comprehensive proposal for improvement with the ultimate goal of producing a uniform model for implementation.

The ACR Bylaws Committee has been expanded to include two members of the CSC and has been charged with reviewing the present bylaws to eliminate unnecessary repetition or ambiguity without changing content. The suggested changes will be presented to the Council in April 2012.

The ACR Executive Committee has been charged with reviewing all recommendations of the past ACR Forum sessions, tabulating progress and accomplishments, determining what is yet undone, and formulating a plan of action.

To further enhance public and member awareness of ACR's value, we have begun a process of promotional video production as well as creation of value links to Case in Point. As a new component of the ACR leadership support practice recognition program, the College will offer a $1,000 annual discount to the ACR Education Center for practices that support a member of the BOC, CSC, or a chapter president.

Progress reports were made by all commission chairs, and the board heard a lengthy report of the activities and future direction of the CSC. Economics and government relations were a central focus of attention. Considerable discussion was devoted to scenario planning and the efforts of the Intersociety Committee to coordinate the radiology enterprise. The issue of creating a new model for nuclear medicine residency training received extensive discussion, and the board voted unanimously to endorse the work of the current training task force, as well as to address the complex issue of collaborative practice guidelines in nuclear medicine.

The highlight of the meeting was the presentation of three point-counterpoint focus sessions, each one hour long, during which pros and cons of major topics were discussed.

The first session held the point that the ACR has longstanding concern with the business model of utilization management provided by radiology benefit management companies (RBMs), and that the College has instead advocated the use of computerized order entry with embedded decision support. It was therefore argued that the ACR should continue this policy and not endorse or collaborate with RBMs. The counterpoint argued that RBMs have become firmly embedded in the private sector and may well enter federal payment systems, that they have a proven track record of savings and, by not recognizing them as valid providers of benefit, the ACR has its head in the sand.

The second session held the point that ACR's longstanding arguments against self-referral have cast a spotlight on the high cost of advanced imaging and have, directly or indirectly, contributed to the legislative and regulatory focus on cutting prices for imaging. It was argued that the fight against self-referral has gained little, if any, traction despite our best efforts, is no longer viable, and that the ACR should abandon this fight in favor of directing its efforts toward helping members thrive within integrated care systems. The counterpoint argued that, if not checked and eliminated, self-referral of advanced imaging will continue to escalate costs, no matter what payment system evolves, and the ACR must continue a vigorous public fight against it.

The third session, presented by members of the CSC, held the point that increased complexity and sophistication of medical care has created a need for clinical specialists to interact with radiologists whose subspecialty expertise is at the highest possible level. It was argued that all radiology practices, especially nonacademic practices, should restructure their organization around the central core of subspecialization, and the ACR should create models for such practice transformation. The counterpoint argued that economic, geographic, and size factors at nonacademic practices make it extremely difficult, if not impossible, to achieve a high degree of subspecialization and that, in the community setting, the concept of a well-rounded, experienced general radiologist is still highly valued, particularly in rural areas, thus recommending that the ACR develop a practice model to support general radiologists.

The Board of Chancellors will next meet in January 2012 and will again report its proceedings to the membership.

By John A. Patti, M.D., FACR

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