One year ago, the College launched the ACR Strategic Plan. Where are we now?
For a strategic plan to be effective, it must be a living document with frequent evaluations, additions, deletions, and modifications to ensure we are meeting the goals. After a thorough review, the ACR Board of Chancellors concluded that we are making progress on all of the objectives in the strategic plan. We have made great strides over the past year.
Throughout this process, we have kept sight of the core purpose of the ACR. Our organization exists to empower the membership to advance the practice, science, and profession of radiological care with a vison of the future. Our vision is for ACR members to be universally acknowledged as leaders in the delivery and advancement of quality health care. In essence, we seek to empower radiology professionals to provide their own value to their health systems, referring physicians, and patients. Let’s look at how we’re doing in each of the six goal areas outlined in the strategic plan.
Health Care Payment Policies and Practice Models
Perhaps most important to all of you is the ACR’s role in health care payment policies and practice models, and this has indeed been a very active area for us over the last year. Our goal is for existing and new practice and payment models to recognize the value delivered by radiology. We must ensure that ACR members are prepared to adapt and thrive within these models. One key objective is to safeguard radiology’s relative value under the existing fee-for-service model and to minimize further payment cuts so we will be well positioned in the transition to alternative payment models.
As we work toward this aim, I am pleased to report that our Economics Commission continues to get outstanding results. Our CPT and Relative Value Scale Update Committee (RUC) activities continue to stem the tide of wholesale reimbursement cuts for our specialty, and the ACR’s credibility remains strong outside of radiology, with CMS, Congress, and other specialties. In addition to surviving the onslaught of challenges to our reimbursement, our RUC team achieved reasonable valuation for lung cancer screening and garnered substantial improvements in practice expense payments for the film-to-PACS conversions in the Medicare Fee Schedule. We avoided site neutrality adjustments in the Hospital Outpatient Prospective Payment System, but we still have work to do on ensuring appropriate packaging and bundling of services.
Due to the efforts of our economics team, we seem to have a less adversarial relationship with CMS than in the past, which will prove useful as we work with the agency on alternative models to fee-for-service reimbursement. On the legislative front, the House passed the 21st Century Cures Act, which includes language that repeals the multiple procedure payment reduction. Unfortunately, this legislation has stalled in the Senate. However, we may see some movement in the next year.
The strategic plan also calls for the ACR to increase its leadership role in defining, developing, evaluating, and advocating for new payment models that promote high-value, patient-centered radiological care. On April 16, 2015, Congress enacted the Medicare Access and Children’s Health Insurance Program Reauthorization Act. In addition to repealing the arcane sustainable growth rate formula for updating the conversion factor for the Medicare Physician Fee Schedule, this legislation defines the parameters and timetable for implementing value-based payments and alternative payment models for physicians in the Medicare program in the coming decade.
To help members comply with the tenets of this legislation, the College has established a multi-commission workgroup to look at all options for radiology to comply with the merit-based incentives payment system (MIPS) and alternative payment model (APM) mandates set forth in the law. This undertaking will be among the highest priorities for the College over the next few years. To enhance members’ understanding of and participation in new practice and payment models that promote high-value, patient-centered radiological care, the College provided focused education at the ACR 2015® annual meeting and at the annual Radiology Leadership Institute® Summit. Our economics, informatics, and quality and safety teams have done a number of webinars about MIPS and APMs, informatics tools, and metrics.
Membership and Member Engagement
Educational efforts at state chapter meetings, webinars for chapter leaders, presentations at other society meetings, and the Imaging 3.0™ Acceleration Program are all designed to help demonstrate the value of ACR membership to radiology professionals.
We are enhancing the policies we use to make sure all volunteers are actively engaged in the work of the College. The Commission for Women and General Diversity continues to promote diversity in the specialty, including publishing two manuscripts in the JACR®. In recognition of the importance of ACR’s young physicians, the Board of Chancellors submitted a bylaws resolution to establish a dedicated Young Physician Section position on the Board of Chancellors. The council will vote on this resolution in May 2016. Finally, we are looking to the future of the ACR and the specialty and engaging with a number of other major radiological societies to encourage medical students to enter the practice of radiology.
Radiology and Patient-Centered Care
Enhancing radiologists’ ability to improve patient experience is a top priority for the College. The College took a big step forward this year when the Board of Chancellors established the Commission on Patient- and Family-Centered Care. In addition, the December 2016 special edition of the JACR will focus on the patient experience. We have also launched resources for lung cancer screening and CT colonography in an effort to foster radiologists’ direct engagement with our patients.
Perhaps the College’s most notable accomplishment this year has been in increasing the range of informatics tools available to radiology professionals to facilitate patient-centered care. In addition to decision support for our referring physicians, we are also working on decision support resources for radiologists to promote standard and actionable recommendations. We continue to add Imaging 3.0 case studies to promote patient-centered radiological care. Recently, the ACR Managed Care Committee put forward the Most Valuable (Radiology) Practice tool, which provides concrete guidelines for incorporating Imaging 3.0 into practice. We continue to advocate for clinical decision support implementation through ACR Select™. Our Committee on Incidental Findings has developed new incidental findings algorithms. Through clinical decision support for radiologists, we hope to make this content available at the time of interpretation in order to decrease variation and improve the quality of our reports.
We were asked to make a presentation to the Institute of Medicine and were pleased that many of our recommendations for integrating radiological professionals into patient care teams were adopted in their report “Improving Diagnosis in Health Care”. The institute’s endorsement of our Imaging 3.0 initiatives will be useful as we engage with CMS around MIPS and APMs.
We are also fostering collaborations with other societies, including the College of American Pathologists, to leverage the tenets of the Institute of Medicine report around specialty-appropriate APMs. Image Wisely® encourages pledging facilities to participate in radiation dose index registries.
The College continues to enhance its role as a global leader in radiological quality and safety. The global community is embracing the ACR Appropriateness Criteria® as the best means for justification of medical imaging. We are collaborating with the European Society of Radiology (ESR) and RSNA to promote the International Society of Radiology as the non-governmental organization advising the World Health Organization and the International Atomic Energy Agency on radiation quality and safety. We also worked with ESR to implement ESR iGuide, which is based on our ACR Select and is now recommended by the World Health Organization and International Atomic Energy Agency.
Innovation and Research
The ACR has reorganized our research center in Philadelphia to assist the National Cancer Institute cooperative groups with their projects and to build and streamline an array of programs designed to support multi-center and industry-sponsored trials. The Neiman Health Policy Institute® continues to be the recognized leader in health services research related to radiological care and will be a valuable asset as we study the economic implications of new payment models. We also continue to partner with a number of academic centers engaged in health services research. Our informatics innovations continue, and we have engaged a number of health IT vendors to pilot tools to bring more information to physicians at the point of care.
The ACR has also been working to strengthen the profession through communication, cooperation, and collaboration with other organizations and stakeholders. In enhancing our external relationships, we are part of multi-society efforts to bring consistent messaging to all radiologists about important issues affecting radiology. We are also working on collaborative projects for medical student engagement with radiology and putting together resources to assist residents’ transition from residency and fellowship to practice. We continue to work with specialty societies outside of radiology to demonstrate the importance of radiology to the care team and to promote a common agenda in areas such as breast cancer screening. Finally, our new Commission on Patient- and Family-Centered Care is beginning to engage patient advocacy groups and include patients as members on all of the commission’s committees.
Our last goal area centers on financial sustainability. Without a viable and financially sound organization, there is no mission. Although the cost of doing business in the Washington area continues to rise at a pace higher than the rest of the country, the financial position of the College remains sound. We have a balanced budget for the 2016 fiscal year. Our program assessment process ensures that all of the College’s programs are aligned with the strategic plan. Lastly, the Board of Chancellors recently established an Innovation Fund, which the ACR reserves to assure we are well positioned to respond to whatever challenges may face our specialty.
Where Are We Now?
In conclusion, it has been a privilege for me to serve as the chair of the ACR Board of Chancellors. The work of the College is not mine but rather the work of our phenomenal board members, Council Steering Committee, and all of the member volunteers throughout the ACR. The College is made up of all of you, and you should be proud of what we have accomplished together. We have a remarkable ACR staff team who are helping all of us every day and every step of the way. The challenges we face are not likely to abate in the near future, but we have a great organization to assist us and our practices. I continue to be most grateful for your continued support.
By Bibb Allen Jr., MD, FACR, Chair