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.

As Bibb Allen Jr., M.D., FACR, immediate past chair of the commission, so expertly summarized in his April 2012 ACR Bulletin column, the last few years have been challenging ones for the ACR membership. As I assemble my to-do list for this new role, I know that it will be critical for the commission to continue to fight on multiple fronts against these threats to imaging reimbursement. It will also be essential, however, to build on our understanding of how radiology will survive and thrive under various potential new payment models and for us to use that knowledge to support you, as your practice environment changes.

The commission oversees both functional and strategic committees. Those of us who volunteer in the Current Procedural Technology® (CPT®), reimbursement and practice expense areas participate in an ongoing process to define new codes and modify existing ones, and the scale has recently tipped dramatically toward modification. Only 53 brand new codes have been created since 2005. Codes are now more commonly redefined and bundled, usually with a reduction in their value, as CMS looks to balance its budget and divert funds towards primary care at the expense of specialists, particularly radiologists. While the commission has carried a significant workload in preparing for and presenting at the three CPT and Relative Value Scale Update Committee (RUC) meetings, held annually, we are also constantly aware of future challenges. As of press time, we will have defined the values of no fewer than 29 codes at the April 2012 RUC meeting, 14 of which were created as bundled codes at the February 2012 CPT Editorial Panel meeting. Some 15 percent of the RUC's agenda was consumed by radiology codes. We are concurrently crafting our approach to defending additional codes that will be presented at future meetings through 2014.

The managed-care, utilization management, and carrier advisory committees, as well as the Medicaid and managed-care networks — which operate at the state level — are on the front lines dealing both with government and private payers. These committees are kept busy by a wide range of issues, from the loss of state Medicaid funds due to implementation of radiology benefit managers to the professional component Multiple Procedure Payment Reduction (MPPR) imposed in the 2012 Medicare Physician Fee Schedule Final Rule. On the Hospital Outpatient Prospective Payment System side, the Commission on Economics monitors this complex payment structure in detail and is a strong voice in this process. The unique role of general, small, and rural practices is represented by a separate committee appropriately named the General, Small, and Rural Practices Committee — whose members' experiences are highly relevant as practice address the implications of the MPPR.

The commission also has committees that pertain to all major clinical areas of imaging and this panel of experts weighs in on issues both in their field and in economics. As we grapple with challenges such as the evaluation of and development of a coding structure for breast tomosynthesis and the evolution of ultrasound technology to include the "small-box" units so prevalent in clinicians' offices, their expertise is critical.

To ensure that there is appropriate time and attention given to strategic thinking, the commission, under Dr. Allen's leadership, created the ACR Future Trends Committee. Their focus on novel payment and practice concepts have proven invaluable in the rapidly evolving world of shared savings and risk models. Taking these concepts into the field, the radiology integrated network will be a valuable resource to mine the experience of members already functioning under these types of payment models to the benefit of those faced with such a change.

As Dr. Allen wrote on page 21 of the February 2012 ACR Bulletin, the commission has most recently developed a research committee, the Committee for Imaging Health Policy and Economics Research (CIPER), to provide the type of evidence and literature support that will be necessary to bolster the College's advocacy effort.

Lastly, a committee devoted to examining how we as an organization provide value to you plays an essential role in driving our strategy. The Value Added Committee reports to you, the membership, on how the commission's efforts have helped to preserve, where possible, your reimbursement. For example, while the reduction in value for the combined CT abdomen and pelvis codes instituted by CMS in 2011 was disappointing to us all, the fact that these bundled codes were first proposed in 2008 and only instituted in 2011 was due to vigorous efforts by the commission to preserve the status quo as long as possible.

The commission has — as Dr. Allen explained last month — the best team and staff in organized medicine; I am proud to have been part of it for the past 10 years. I look forward to further serving with the talented members of the commission and with our superb staff in my new role as chair.

Geraldine McGintyBy Geraldine B. McGinty, M.D., M.B.A., Chair

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