We’re Stronger Together
As we gather for ACR 2015, our message is magnified by our numbers.
"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
Margaret Mead’s oft-quoted exhortation is apt as we gather together as a profession this month in Washington. The power of our combined voice is never stronger than when we flock to Capitol Hill en masse to meet our legislators and tell them the story of what we do for our patients and how we deliver high-value health care.
In 2013, many of you visited your representatives with the beta version of the ACR Select™ mobile app loaded on your smartphone. The app showed exactly how we can contribute to lower costs and higher quality through the use of clinical decision support for imaging. Don’t doubt for a minute that you made a very real contribution to building support for the Protecting Access to Medicare Act that in 2017 will embed the use of CDS into the Medicare program.
But lest you think that our advocacy efforts stop when we all go home, nothing could be further from the truth. I see everything that we do as radiologists and at the ACR as advocacy for our patients. We advocate for fair reimbursement for the services we provide to make sure that our patients have appropriate access to those services. We advocate for quality metrics that differentiate high-value imaging so our patients can rest assured that they are receiving, as Dr. Bibb Allen, our board chair, said, “all the imaging care that is beneficial and necessary and none that is not.” And our efforts to serve our patients must be integral to everything we do. From our individual practices to our unified efforts as a profession, we need to be a strong, clear voice on behalf of our patients.
Could a cynical person suggest that we are thinking only of ourselves as we advocate around payment policy issues? Well, there will always be skeptics. But we have been successful in influencing policy-makers and payers on issues, such as CMS’s decision to cover lung cancer screening, because it has been readily apparent that our goal is the best care and appropriate access for our patients. Have we sent a clear message that reimbursement has to reflect the costs of providing the service? Absolutely. For example, based on the input of clinical experts such as Dr. Ella Kazerooni, who led the ACR’s lung cancer screening effort, we believe that a low-dose screening CT with all the associated quality management activities and outcomes tracking requires more physician and technologist work than a non-contrast chest CT, and we’ve made that representation to CMS.
In the area of breast tomosynthesis, we have strongly advocated to private payers that it is not, as many have continued to state, experimental. Tomosynthesis is a technology that can improve patient outcomes. But if it’s not reimbursed, it will not be available to as many women as can benefit from it. We’ve seen the power of local advocacy in this area, with payers responding to efforts at the state level from many of you. Your patients are better off for those efforts.
But advocacy is also important at your practice or institution. Your expert voice is critical to making sure imaging is used wisely and appropriately. You advocate for your patients when you tell the story of clinical decision support to your physician colleagues and health system leadership.
Across the various ACR commissions, we are always looking for ways to amplify the voice of radiologists. One of the things that keeps me awake at night is the continued attacks on the validity of mammography. With real screening compliance much lower than one might expect, I worry that our patients are being told they don’t need this scientifically proven life-saving service. It’s been frustrating to see experts in our field ignored and accused of bias when they try to respond to misinformation and bias from others. I was delighted therefore to participate in a program under the joint auspices of the ACR’s Commissions on Breast Imaging, Quality and Safety, and Economics to train a new generation of advocates for the benefits of screening mammography. Luminaries such as Drs. Daniel B. Kopans, Edward A. Sickles, R. Edward Hendrick, Mark A. Helvie, and Carol H. Lee, as well as Dr. Robert Smith from the American Cancer Society, gave generously of their time to host weekly webinars digging deep into the science that supports screening. A group of dedicated “trainee” radiologists who are already in practice and many in leadership positions spent not only the 10 hours of the webinars but did pre-reading, answered questions, and responded to last minute requests for comments on news articles to hone their skills. The group finally assembled during the Society of Breast Imaging Symposium last month for media training. We should all sleep easier knowing that the torch will be carried by this talented and passionate group of advocates.
By Geraldine B. McGinty, MD, MBA, FACR, Chair