Changing Platitudes to Attitudes
MACRA Legislation means the Time for Action is Now.
In November 2014, David C. Levin, MD, FACR, gave the RSNA’s Annual Oration in Diagnostic Radiology. In his address, Dave challenged us all — radiologists and our specialty societies alike — not to let our specialty societies’ value-based initiatives become merely “convenient slogans” for the specialty.
Dave is concerned that programs such as Imaging 3.0™ will only be used to make us feel good about ourselves instead of becoming the drivers for the value-based changes that will not only improve the practice of radiology but will also be requisite for complying with federal health care reform initiatives that are taking place as part of the Medicare Access and CHIP Reauthorization (MACRA) legislation of 2015.
I believe Dave’s concerns are appropriate. He worries that many of us will not make real changes in our practices and instead wave the Imaging 3.0 banner without giving enough thought to what is really behind it and, more importantly, what it requires us to do.
Dave’s admonishment for us is that we “cannot afford to let that term [Imaging 3.0] become just a meaningless platitude.” I could not agree more.
Dave went on to say that in order for radiologists to provide real value for our patients, referring physicians, and hospitals, we must be able to walk the talk. “It is the more difficult path but the one we must take to assure a good future for our specialty,” he said. The value path is a difficult one because it requires us to do more work to provide those value-added services, yet most of us are still rewarded financially based on the volume of studies we do, with little reward for any extra value-added care we provide. So what will be the incentive for change?
I cannot begin to tell you the number of calls I have had asking why we cannot get a new CPT code to bill for services such as consultations for appropriateness or our conversations with referring physicians or patients. This thinking is, of course, based on how to manage our practices in our current fee-for-service (FFS) payment system. In that environment our payers are not going to be receptive to added services or payments despite the fact that it could save them money in the long term. So what we have here is a catch-22, where neither payers nor physicians are truly ready to make the first move. Payers will say they demand value but only if it decreases costs. Meanwhile, physicians want to provide more value as long as the metrics are meaningful and we don’t have to work harder to make less money.
So how are we going to get where we need to go? One thing seems certain: if payers don’t provide the incentives to promote value-based care for their beneficiaries, then physicians are not likely to change and our initiatives could well become the meaningless platitudes Dave fears. However, I believe the MACRA legislation is signaling a long-awaited shift toward value-based care in Medicare, and once these changes occur other payers will follow.
At that point, we won’t be able to rely on the slogans of our specialty societies to carry the day. We will have to make the practice-level changes that will maximize our payments under the new Merit-Based Incentive Payment System (MIPS) initiatives and within alternative payment models. If we don’t, we will suffer further payment decreases and lost business.
But what exactly will those changes be, and how will they be implemented and reported to our payers? For small and medium-sized practices like mine, figuring that out on our own would be a daunting challenge. Enough, quite frankly, to make me want to put my head in the sand and just keep reading more cases too.
Fortunately, we will not be alone in the battle to figure out what to do to be appropriately compensated for value-based changes in our practices. The College will be our partner every step of the way. The ACR is working with CMS and other payers to set the metrics and define alternative payment systems for radiology. The College will then provide practices with tools to implement the changes and report them to payers.
I hope you were able to see the webinar “A Post-SGR Guide to New Value-Based and Quality-Based Reimbursement Models” by Ezequiel Silva III, MD, FACR, and Gregory N. Nicola, MD, in September. If not, it will continue to be available through the Radiology Leadership Institute–Imaging 3.0 webinar series. The webinar discusses what the College will be doing over the next year as we work with CMS and other payers to ensure that they recognize the unique value radiologists provide to the health system and develop alternative payment systems that make sense for our practices.
Additionally, we are compiling current alternative payment model information from practices around the country. Geraldine B. McGinty, MD, MBA, FACR, chair of the ACR Commission on Economics, has put together a team to draft recommendations for CMS outlining how best to set up alternative payment models for radiologists. Once these are defined, the College will ensure that practices have access to the tools necessary to implement and report the changes. This toolkit is well underway and involves essentially every commission of the College. So while Dave asserts that radiologists will have to be their own change agents, I believe that it will ultimately be the strong partnership between the College and our members that will allow us to succeed in our post-SGR, post-FFS world. Through that partnership, Imaging 3.0 will move from a platitude to a true attitude for the future practice of radiology.
By Bibb Allen Jr., MD, FACR, Chair