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

So starts Charles Dickens' epic novel of the French Revolution, A Tale of Two Cities. The cascade of cuts that we are facing as a specialty could certainly make one feel that it is the worst of times. Our recent troubles started with the 2006 Deficit Reduction Act and have continued with the recent fiscal cliff wrangling over the holidays, which resulted in a planned increase in the utilization rate assumption. This increase will reduce outpatient imaging payments for services rendered to Medicare beneficiaries by an estimated additional 10 percent starting next year.

And yet, if we are to continue as a viable specialty we need to find our spring of hope. As we continue to fight against the reductions in fee-for-service payments that both Congress and CMS have layered onto us, we need to find a new path forward. That path may seem very far from the well-traveled fee-for-service route that served radiologists so well until recently. It involves a recognition that payments for volume are going to be outstripped by payments for value. This is a theme you have heard many times in the last year from the ACR as well as from health-care experts and policymakers. And it is a drumbeat we ignore at our own peril.

So while the radiologist of the past clings to the notion that reading more cases will help make up for decreased unit reimbursement, the radiologist of the future plays a pivotal role in directing appropriate imaging utilization to ensure that only those studies that can deliver the most effective information are performed. The radiologist of the past hunkers down over his PACS workstation and does not have time to talk to anyone; the radiologist of the future attends rounds and regularly makes visits to the exam room to elicit more history from a patient or discuss a result.

As we continue to fight against the reductions in fee-for-service payments that both Congress and CMS have layered onto us, we need to find a new path forward.

Life is not a storybook, however, and your ACR economics advocacy team understands that you can't just leap into a value-based payment model without the appropriate incentives. This is where our efforts with policymakers are crucial. Just as primary-care physicians are now being incentivized to actively manage their newly discharged patients through the establishment of new care-management codes, radiologists must be incentivized an rewarded for providing high-value imaging care. So far, unfortunately, all we've seen from CMS and Congress are sticks, with barely a carrot in sight.

Physician Quality Reporting System opportunities for radiologists are fewer than they should be, and the value that only radiologists can provide in directing appropriate imaging utilization has yet to be recognized. These opportunities form the basis of our current efforts with lawmakers as well as driving home the notion that although cuts may have to be made, they must not disproportionately impact one specialty and they must be rational.

While the ACR works tirelessly to promote high-value imaging care — through a concept called Imaging 3.0, which we'll be launching in May at AMCLC — there are things you can do to start cautiously exploring this new path, several of which I touched on in my January Bulletin column, "Realistic Resolutions." Staying on the old path may seem even more tempting to compensate for changes by picking up the pace on productivity. But while these paths don't quite lead to a dead end, they are certainly not going to lead you towards becoming part of the new, integrated health care-delivery philosophy that has been baked into our payment system. In other words, we need to find a new path to success.

At the very least, you can maximize participation in the PQRS measures that currently apply to imaging. To help you, the ACR introduced the PQRI Wizard™, located at http://bit.ly/ACRPQRIWizard. This easy-to-use online tool guides physicians through the steps necessary to rapidly collect, validate, and submit their results to CMS for payment.

Time is running out before this baby carrot becomes a big stick and turns from an incentive to a penalty. We are at a crucial time in our specialty's evolution, and your economics team is committed to helping all of the ACR's members manage these challenging times. As always, I'd love to hear your feed back at This email address is being protected from spambots. You need JavaScript enabled to view it.. You can also follow me on Twitter (@gmcginty).


geraldine mcgintyBy Geraldine B. McGinty, MD, MBA, Chair

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