2018: More Transitions and Opportunities for Preparation

NOV ecochair
In the coming year, let’s get involved and start reporting clinical decision support codes and patient-relationship categories and codes.

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Radiology Considerations Under Year Two of the QPP

ECON oct

CMS is calling on physicians to ramp up their QPP participation in 2018.


Next year, 2018, is the second transitional year for the Quality Payment Program (QPP) before full implementation in 2019. CMS still offers the “pick your pace” option for level of participation.

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Economics Goes Local

Thanks to MACRA, some changes to the way we practice are
originating at the regional level before rolling out nationwide.

econchair
The Medicare Access & CHIP Reauthorization Act (MACRA) is often described as a shift in payment policy from volume to value. MACRA could also be described as a shift from national to local.

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The Cornerstone of Radiology Economic Policy: Our Volunteers

The members of the ACR Commission on Economics make far-reaching contributions to health care.cornerstone

As the chair of the ACR Commission on Economics, I lead more than 700 devoted volunteers. This column allows me to thank these volunteers and invite more ACR members to join us.

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How We Got Here

Radiologists in the United States have a history that is different from that of other physicians — and understanding this history is important to the future of radiology.how we got here

Health care and payment policy are evolving rapidly in this country. New laws and regulations are voluminous, and the decisions we make are far-reaching.

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MACRA and Informatics

How do technology tools factor in to new reimbursement models — and what does it all mean for radiology?MACRA and informatics

As I'm sure you've heard, 2017 is the first performance period of the MACRA-derived Quality Payment Program (QPP). The QPP includes two payment pathways, and almost all radiologists will be scored under the Merit-Based Payment System (MIPS).

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The Economics of Machine Learning

How will emerging technology affect radiology in the near future?economics of machine learning

"DeepRadiology Announces the World’s First Fully Autonomous Radiology Interpretation System.” This news story, released during RSNA 2016, was followed by two statements:

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TBD: Radiology's Role in Alternative Payment Models

Radiology must evaluate its role in the rapid evolution to alternative payment models.alternative payment models

Fifty percent of all Medicare payments will occur through alternative payment models (APMs) by 2018. This ambitious goal was first introduced by the secretary of the Department of Health and Human Services early in 2015.

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Patient Experience and Payment Policy: One and the Same

The Commission on Economics is committed to ensuring opportunities for radiologists contribute to an improved patient experience.Patient Experience

Continually improving patient experience is what we strive for; it is the right thing to do. But if that were not motivation enough, policymakers have made patient experience an integral component of radiology payment policy.

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The Highs and Lows of Lung Cancer Screening

All eligible patients should have access to lung cancer screening.lung cancer screening

Screening studies are among the most important services radiologists provide. Our ability to deliver these services requires scientific evidence that demonstrates improved outcomes.

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Pick Your Pace Under MACRA

The ACR Commission on Economics stands ready to provide tools for radiologists to achieve Quality Payment Program Success.

MACRA pace silva

The Medicare & Chip Reauthorization Act (MACRA), now referred to as the Quality Payment Program (QPP), will impact radiology payments beginning in January 2019. But the performance period for 2019 started on January 1, 2017. Well, sort of.

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Want to Get Paid More? Take Some Risk.

The ACR Commission on Economics is evaluating the role of risk in expanding alternative payment models.

econchair11 14

Practicing radiology is risky. Running a radiology practice is risky, given not only the capital-intensive nature of what we do but the complicated regulatory environment that surrounds us.

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The Challenge of Protecting Mammography

The ACR Commission on Economics continues its efforts to maintain the economic viability of mammography services.mammogram

The coding and payment structure for mammography services changes on Jan. 1, 2017. Over the past three years, the Commission on Economics has worked to ensure the best outcomes for mammography services.

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Transforming Practices

More than 140,000 clinicians will be transforming their practices over the next four years. The ACR Commission on Economics wants radiology engaged.transforming practice

"Better care, smarting spending, and healthier people." CMS has committed $685 million to support these important goals through the Transforming Clinical Practice Initiative (TCPi). It is imperative that we are engaged in this effort. In this column, I describe ways in which radiology can participate.

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Are We Ready for Round Two of ICD-10?

It’s time for every radiology practice to identify its ICD-10 champion.are we ready

We survived round one of the ICD-10 implementation. As you've probably heard, ICD-10 is the revised system for diagnosis coding.

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New Chairs, Same Mission

As the cast of volunteers evolves, the Commission on Economics continues to work to maintain payments and ensure radiology’s place in future payment systems.

august economics 

The Commission on Economics thanks the outgoing chairs and welcomes the new chairs who will lead the following important committees: Managed Care, the Radiology Integrated Care (RIC) Network, Interventional Radiology (IR), Academic Radiology, and Reimbursement (RUC). I discussed our new MACRA Committee and its chair, Greg Nicola, MD, in last month’s July column.

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Understanding Episodes of Care

The Commission on Economics is working to define radiology’s place in episode groups.july bulletin episodes of care

What role does radiology play in clincal care? This is a wide-open question with multiple potential answers.

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The New MACRA Committee

The Commission on Economics goes into operational mode as it approaches new payment models.

Econ chair

The Commission on Economics has known for years that a transition from volume- to value-based payment is inevitable. As early as 2001, “Crossing the Quality Chasm: A New Health System for the 21st Century,” a report published by the Institute of Medicine, called for “aligning payment policies with quality improvement” and “bundled payments for priority conditions.”

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What’s Next for the Commission on Economics

The College is charting a course for success in a changing world of reimbursement and incentives.

Map

This is my first column as incoming chair of the ACR Commission on Economics.

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MACRA: One Year On

MACRA’s first anniversary is upon us. Where are we now?

AprilEcon
It’s hard to believe that a year has elapsed since the overwhelmingly bipartisan passage of the MACRA (Medicare Access and CHIP Reauthorization Act) legislation that repealed the Sustainable Growth Formula and set us on an accelerated trajectory toward value-based payments.

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Beating Back the MPPR

A recent decision from Congress rolls back one of radiology’s most maligned reimbursement cuts.

Econ

We’ve faced arbitrary cuts to the reimbursement for imaging services in recent years, but none rankled quite as much as the multiple procedure payment reduction (MPPR) for the professional component (reimbursement for the interpretation of images).

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Keeping Patients at the Forefront

As the health system shifts, radiologists must stay in tune with the needs of their patients.
EconChair 1 19

As I write, open enrollment season is closing and many of our patients are selecting their health insurance plans for 2016. Five years after the signing of the Affordable Care Act, we have seen the number of uninsured Americans drop significantly. There have been, however, concurrent significant changes in the design of health care benefit plans.

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Delayed Decisions

CMS has postponed the deadline for clinical decision support. But change is coming, and radiologists will be at the forefront.

EconChair

January 2015

We've heard the rallying cry so many times now that it almost feels cliché. We need to stop rewarding volume and start prioritizing value in health care. Last spring, Sylvia Burwell, secretary of Health and Human Services, announced an ambitious target — 90 percent of Medicare payments will be tied to value by 2018.

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Getting Specific About Patient-Centered Care

The chair of ACR’s newest commission looks at where radiology fits into value-based health care.

EconGears

November 2015

For my column this month, I spoke with James V. Rawson, MD, FACR, about his latest role at the ACR, as chair of the brand new Commission on Patient Experience. I’ve worked with Jim for several years in his role as chair of our Committee on the Hospital Outpatient Prospective Payment System (HOPPS) and treasure him as a colleague and friend.

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Happy Birthday,Medicare and Medicaid!

Fifty years after their inception, both programs continue to evolve with the shifting health care landscape. Where do radiologists fit in?

Birthday

September 2015
This summer retired U.S. Senator Bill Frist, who (as most of you know) was a practicing physician before entering politics, and Drew Altman, president and CEO of the Kaiser Family Foundation, wrote an excellent overview of the Medicare and Medicaid programs in JAMA.

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Taking Stock

With new payment models throwing health care into transition, now is the time to remember why we became physicians in the first place.

HiRes2

August 2015

It’s August and I hope that you all are enjoying at least a little downtime this summer. Even my hectic adopted city of New York is quieter these days, and it’s a good time to recharge the batteries.

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Medicare’s Proposed Rule for 2016

Changes are just around the corner.

ChangesEcon

July 2015

Medicare published the Proposed Rule for 2016 later than usual. Typically it’s issued just before the July 4th holiday, but this year it dropped almost a week later.

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Reimbursement Revolution

Value-based payments are coming. How is the ACR positioning radiology for success in this new system?
EconChair

June 2015
On April 16, 2015, President Obama signed into law a potentially game-changing piece of legislation related to radiology payment policy.

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We’re Stronger Together

As we gather for ACR 2015, our message is magnified by our numbers.

capitol 

May 2015

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." —Margaret Mead

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Lung Cancer Screening Update

As this valuable coverage rolls out to patients, the Commission on Economics works to tie up loose ends with CMS.

EconChairMic 

April 2015

On April 6, Dr. Ella A. Kazerooni and I gave a webinar on lung cancer screening.  More than 1,500 people signed up for the webinar. We were able to accommodate only 1,000, so a recorded version is available.

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Patients and Pricing

Educating our patients about the true costs of imaging reaps benefits throughout the health care system.

 pricing

March 2015

I've written before about how we need to take a leadership role in helping our patients understand the value of the care and services we provide as radiologists.

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Quiz Time!

Answer these questions to uncover your superpower and conquer your kryptonite.

EconColumn

February 2015

I know that none of my esteemed readers ever spends time on the Internet looking at cute cat videos or taking those Buzzfeed quizzes that reveal the answers to life's important questions, like "How Well Do You Know the Thanksgiving Episode of 'Buffy the Vampire Slayer'?"

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Out with the Old, in With the New?

The 2015 Final Rules hint at what's to come in the year ahead.

EconPic

January 2015 

The commission on economics always meets face to face at RSNA, and this year we used the ACR’s new strategic plan to develop our priorities for the year ahead.

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Naughty or Nice

Which list will CMS be on this holiday season?

CMS Naughty or Nice, ACR Bulletin, December 2014

Performance-based incentives are nothing new and are certainly not unique to health care.

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Eating Our Seed Corn

Our youngest members are entering practice amid tectonic changes in the landscape of medicine. How are we supporting the next generation of radiologists?

Commission on Economics: Eating Our Seed Corn

One of the most rewarding aspects of my job as chair of the Commission on Economics is the work I do with the Resident and Fellow Section.

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Imaging 3.0™: Where Are We Now?

Taking stock as the radiology wide initiative takes hold and transforms the specialtyImaging 3

In last october's column, I wrote about how Imaging 3.0™ had taken hold across the profession. A year later, I'm pleased to report that it is embedding itself in our culture and informing every activity of the College.

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Happy 4th to You Too, CMS

The recently released proposed rules contain both good news and bad news for radiologists

fireworks

When I saw the tweet from @CMSGov on July 4, I couldn’t resist an eye roll.“Happy #July4th!” it said.

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Bundling up...In August?

The ACR economics team is focused on positioning radiologists to thrive in both existing and emerging payment models.bundled up

You might wonder why I am talking about bundling up when I hope this column finds you enjoying the warm summer weather. Well, "bundling" is quite a buzz word in health care payment policy these days. Its impact on radiologists will be far reaching and, in fact, has already been significant.

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Get to Know Your CFO

Establishing relationships with leaders in your health system can be beneficial for both your department and your patients.Get to Know CFO

For those of us who work within a hospital system, its corporate leadership can seem very far away from our daily lives. The so-called C-suite (home to the CEO, CFO, CMO, and COO, depending on the local vernacular) often seems to exist on a different planet than the reading room.

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A Commitment to Doing It Right

The ACR advocates to bring lung cancer screening to patients in need.doing it right

Last December, the United States Preventive Services Taskforce (USPSTF) finalized its recommendation and gave a grade of B to lung cancer screening with low dose CT.

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The Price is Right

A comparison of out-of-pocket costs reveals the complexities of imaging pricing.price is right

When does an x-ray cost more than an MRI? I found out recently, when a relative of mine needed both for a sports injury.

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Part of the Solution

As the health care system shifts, radiologists are on the frontlines of patient care — but ongoing reimbursement cuts from CMS are hampering physicians and will ultimately affect patients.in search throwarth

As radiologists, we’re all well aware of, and fully on board with, the need to deliver highvalue health care at a lower cost. We’ve been singing from the quality hymnal for years through our leadership in accreditation and evidencebased imaging.

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Preparing for the Future

The RFS Journal Club brings together members-in-training to learn about radiology economics now and going forward.Prepare for future

I often hear from radiology residents that they’d like to be more involved in the College’s economics advocacy efforts and that they need to know more about the payment policy process.

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Revisiting Resolutions

As 2013 comes to an end, have we met our goals?75672205 thumbnail

Last January my column was titled “Realistic Resolutions.”(Read the article at http://bit.ly/DrGResolutions.) I talked about ways that we as radiologists could take concrete steps to demonstrate our value. So as we head into 2014, where are we as a specialty, and are those resolutions still relevant?

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Thanksgiving Turkeys

As we await decisions on CMS policies, radiologists wonder what will be on the table this holiday season.Thanksgiving turkeys

As I write this column in mid-September, I wish I had a crystal ball. Will we as radiologists have much for which to be thankful when the November Bulletin is printed?

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Long-Term Commitment

Radiologists nationwide breathe life into Imaging 3.0™.long term commitment

Imaging 3.0™ was launched at the 2013 AMCLC as a way for radiologists to demonstrate their value in the new health-care world. Now, five months later, where are we in telling and living this important story?

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Back to School

While many individuals have filled the past few months with summer fun, the ACR has been busy innovating.back to school

Who can forget that "back to school" feeling? Starting a new school year was always energizing for me, even if there was some regret that the lazy days of summer were over.

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Taking the Reins

As the ACR economics team responds to the latest releases from CMS, radiologists ponder ways to enhance their role in care delivery.taking the reins

July 4th is a great American holiday. As a naturalized citizen, I love everything about Independence Day, from the national anthem to the fireworks.

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A Jolly Good Fellow

The College's collective voice is a powerful and influential tool.a jolly good fellow

By the time this column reaches you, I will have recently joined the ranks of ACR's Fellows. ACR Fellowship recognizes members who "demonstrate a history of service to the College, organized radiology, teaching, or research."

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Radiology's Unlucky Number

Understanding the story behind CPT® Code 73721 and what it means for the future medical reimbursement.Radiologys unlucky number

CPT® code 73721, non-contrast lower extremity MRI, is the poster child for what has happened on the technical side to radiology reimbursement in the past seven years.

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A Tale of Two Radiologists

Let's take advantage of the incentives we have before we lose them.tale of two

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us. — Charles Dickens

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A Fiscal Cliffhanger

Don't let political shenanigans distract you from what's truly important — your patients.a fiscal cliffhanger

I was lucky that in the aftermath of Hurricane Sandy, I only lost my car. So many others' lives were devestated, and many are still recovering.

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Realistic Resolutions

This year let's set some goals that will benefit our patients, our practices, and our specialty.realistic resoluton

If, like me, you make (and break) the same old New Year's resolutions every year, maybe it's time to think differently for 2013.

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Great Expectations

Challenging ourselves to meet the service expectations of our patients.Great Expectations

I came across an opinion article in the New England Journal of Medicine that I thought had some valuable lessons for radiologists.

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What Constitutes a Session?what constitutes

"I know it when I see it." The phrase became famous in 1964, when U.S. Supreme Court Justice Potter Stewart used it to describe his threshold test for obscenity in Jacobellis v. Ohio.

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Déjà Vu All Over Againdeja vu all over again

When you work at Montefiore Medical Center in the Bronx you pretty much have to be a Yankee fan.

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One Size Does Not Fit Allone size does not fit all

My practice is located on Long Island, New York, and is a largely outpatient multi-specialty and multi-site group, in which 35 of the 65 doctors are radiologists. There, my own role is to exclusively interpret breast imaging.

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Taking the TorchTaking the Torch

My first column as chair of the ACR Commission on Economics provides an opportunity to survey the landscape and set out our priorities for the months ahead.

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Preparing For Transitionspreparing for transition

The work of the Commission on Economics is one of several major ways we provide value to its members and our specialty.

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Chipping Away

Modest victories over Medicare’s irrational payment policies could pay off in the future.chipping away

As public policy makers have looked for ways to pay for the ever-increasing costs associated with the Medicare system over the past decade, there have been a number of policy decisions both in Congress and CMS that have specifically targeted and negatively impacted radiology.

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Finding Ways to Demonstrate Value

New committee promotes and coordinates efforts to measure the importance of imaging.Demonstrating Value

To allow the College to play an integral role in coordinating imaging health-policy research, I am pleased to announce that John A. Patti, M.D., FACR, chair of the ACR Board of Chancellors has recently approved the request of the Commission on Economics to create the ACR Committee for Imaging Health Policy and Economics Research (CIPER).

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Continuing the Fight

CMS finalizes 25 percent professional component multiple procedure payment reduction.continuing the fight

By the time this article is published, the Super Committee will have provided its report on Medicare payments to physicians, and imaging-specific legislation may have been passed.

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CMS Finalizes Payment Reductionspayment reduction

In the Final Rule for the 2011 Medicare Physician Fee Schedule, the CMS finalized its proposals for reduced Medicare payments for imaging services discussed in the notice of proposed rule making.

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The Congressional Forecast for Radiologythe congressional forecast

2010 was another hectic year of the Economics and Government Relations Department. With the election of Sen. Scott Brown, R-Mass., to the U.S. Senate last January, many believed that comprehensive health-care reform legislation could not be passed.

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