Just How Much Does That Imaging Study Cost?
As patients shoulder a larger share of their healthcare spending, the executive director of one radiology practice wonders how quality can be incorporated into imaging decisions.
Without a doubt, patients are shouldering a larger portion of their healthcare spending these days. This takes the form of higher premiums, deductibles, copays, and coinsurance. In my role as the executive director of Grand Traverse Radiologists, PC, I have observed that, as a result of these higher costs, patients are beginning to demand greater price transparency — a trend that is also borne out in the literature.
Our Continued Commitment to Fee-for-Service
Volume-based payment remains important to radiology's growth,
and the ACR is committed to protecting it.
I became chair of the ACR Commission on Economics in 2016. At that time, my first ACR Bulletin column described several guiding principles for the commission, one of which was protecting our place in fee-for-service (FFS) payment systems. Since then, most of my columns have centered on value-based payment systems.1 My focus on new payment models makes sense, because the rules and regulations associated with the MACRA-created Quality Payment Program are evolving quickly. We will be affected. But I would not want there to be the impression that our commitment to protecting legacy payment systems has lessened during that time. As I have stated before, FFS payment systems will remain a significant contributor to our revenue and will form the basis for new payment models for the foreseeable future. As such, our commitment is as strong as ever.
It’s All About the Patient
The Economics Forum stressed fair payment and patient-centered care.
Ezequiel Silva III, MD, FACR, moderates the Economics Forum.
The Economics Forum kept true to course with focal points on upholding fee-for-service payments, navigating the ongoing (yet manageable) evolution of MACRA and the Protecting Access to Medicare Act (PAMA), as well as embracing population health management.
My Rutherford-Lavanty Fellowship Experience
In June, I had the honor of traveling to Washington, D.C., as part of the ACR Rutherford-Lavanty fellowship in government relations. This prestigious fellowship offers radiology residents a rare opportunity to experience, first-hand, how healthcare policies are formed in our nation’s capital. Named in honor of the first ACR lobbyist, J.T. Rutherford, and Donald F. Lavanty, ACR’s principal legislative consultant for 42 years, the fellowship began in 1993 and close to 200 enthusiastic radiology residents have participated in the program. On average, three to eight radiology residents serve as fellows, spending one week at the ACR’s government relations office working with staff on current healthcare issues affecting the specialty.
2018 AMA Annual Meeting Recap
While radiologists are increasingly showing their willingness to advocate on behalf of their specialty, there are issues of a certain scope and scale that demand that the entire house of medicine work in concert. When legislators and their constituents want to hear from doctors as a whole, the AMA — the largest single physician organization in the U.S. — is relied upon to craft and communicate a response. That is what the AMA House of Delegates (HOD) — composed of over 500 representatives from every level of training and specialty — sought to do at the recent AMA Annual Meeting in Chicago.
An informed healthcare consumer seeks care for recurrent kidney stones only to walk away with a steep bill. How could price transparency have helped?
During the nearly 20 years I practiced as a thoracic surgeon, medical technology and its costs spiraled exponentially. With the growing influence of insurance companies as third-party payers, most physicians have become familiar with the often opaque requirements which accompany requests for expensive imaging studies now used routinely, such as MRI and CT. During a recent attack of recurrent kidney stones, I encountered first-hand how this situation can negatively impact the patient. Even given my intimate knowledge of the inner workings of today’s healthcare system, I was surprised and ultimately frustrated with the myriad problems patients routinely encounter in seeking care.
Two Sides of the Same Coin
How a radiology ratings website could balance quality metrics with costs to the patient — all while helping to prevent radiologists from becoming commoditized.
From the moment I saw my son at school, I knew something was wrong. He was crying inconsolably and holding his elbow in flexion. We drove straight to a children’s ER, and the X-rays told the story: my 6-year-old had a displaced lateral condylar fracture, which would require surgery.
Cost — Rarely Understood but Highly Relevant
Practices may review their Quality and Resource Use Reports to better understand how they are doing with cost.
Cost, cost, cost. More and more, we hear that physicians are being held accountable for cost.
Price Transparency Blog Series
The term price transparency, a label meant to evoke the idea of openness in healthcare pricing, often means different things to different people. Patients might define it as gaining an understanding of the out-of-pocket costs they’ll incur as a result of a medical procedure; on the other hand, a medical practice may consider itself transparent if it is forthcoming about the total cost billed.
The Importance of Speaking Econ
Economic terms are complex, but learning how to apply them can pay dividends.
The language of radiology is complex and, in many ways, different from the language of the rest of medicine. This difference has immediate implications for our profession.
PAMA Pushes AUC Forward
Following the implementation dates and guidelines for Appropriate Use Criteria is both important and confusing. Read the most current mandates to maintain your reimbursement status.
Navigating the Site-Neutral Payment Debate
As policymakers craft site-neutral payment policies, the ACR considers its strategies.
Medicare and private insurers commonly pay more for a service in the hospital than they do in the office. For instance, a lumbar spine X-ray pays almost five times more in the hospital than the office.
A Moving Target
As patients assume more responsibility for financing their own healthcare, price transparency in imaging should be on every radiologist’s radar.
Ever since taking a spill two weeks ago, Mr. Grant has experienced lower back pain. Worried about the lingering aches he’s feeling, he sets up an appointment with his primary care physician (PCP). After an evaluation, his PCP recommends that he get imaging work done at an outpatient imaging center affiliated with the hospital.
Cost Lacking in Shared Decision-Making Discussions
Lack of awareness of the price of imaging keeps patients from making informed choices on care.
Shared decision-making is a term applied to the communication process between a physician and patient. It balances information asymmetry: the physician knows the medical aspects and the patient knows values, lifestyle and treatment preferences. Discussions between physician and patient include available treatment options, potential outcomes, risks versus benefits, and patient values and preferences.1-3
The Cornerstone of Radiology Economic Policy: Our Volunteers
The members of the ACR Commission on Economics make far-reaching contributions to health care.
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.
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.
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.
Investing in Radiology
The College's strategy for financial sustainability ensures a solid foundation for radiologists and their patients.
The ACR was established to serve the needs and interests of radiologists. While the challenges the profession faces have changed over time with the ever-shifting health care environment, the heart of the ACR has never wavered.
Here's what you missed
The Bulletin team has loved our time at ACR 2017. Radiologists engaged with patients, grew confident in the role with machine learning, advocated on the Hill, and learned about the most important topics facing the specialty, among countless other activities. We've rounded up some of the best news from the meeting in case you've missed it. See you next year at ACR 2018!
ACR 2017: A Day on the Hill
Radiologists from around the country flocked to Capitol Hill to take radiology’s message to Congress.
On Wednesday, ACR members went to Capitol Hill to advocate for the specialty and be the voice of radiology. Check out some of the action shots below. If you'd like to learn about the talking points for this year's Hill Day, please visit the Hill Day Prep page.
Capitol Hill 2017
All you need to know for Hill Day
On Wednesday, ACR members head to Capitol Hill to discuss issues at the intersection of patient care and legislation. Here are the big issues members raised with their representatives during ACR 2017.
Neiman Institute Releases Breast Screening Bundle Tool
A new free resource allows radiology practices to estimate professional, technical, and global bundled prices for breast cancer screening bundles using different assumptions for which services are included, service utilization, and reimbursement rates.
From Practice to Policy
How the RAN influences legislation affecting radiology, and how you can get involved.
The Radiology Advocacy Network (RAN) launched in 2012 to educate radiologists about important issues and guide their participation in legislative advocacy.
Antitrust in Medicine
Recent legal changes are altering the competitive landscape in health care.
In the past, we have written extensively about the concept of antitrust law while noting that the government seemed to show little interest in using it to regulate consolidation in the hospital and medical insurance areas.1, 2
MACRA and Informatics
How do technology tools factor in to new reimbursement models — and what does it all mean for radiology?
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).
Primer on Radiology Advocacy
"An idea is like a play. It needs a good producer and a good promoter even if it is a masterpiece. . ." — David Bornstein in How to Change the World: Social Entrepreneurs and the Power of New Ideas
Residents and fellows are perfectly positioned to be effective advocates as we are accustomed to championing our patients and specialty from our reading rooms, angio suites and clinics every day; however, most of us are not comfortable pursuing state and national advocacy opportunities. This daunted me, too when I was first getting started, but rest assured, there are countless opportunities to get involved (and options compatible with almost everyone’s time budget).
Let’s review a few pieces of advice I have learned along the way and share some opportunities for you to get started advocating today!
Evaluating the impending impacts of the machine-learning economy
Karl Benz is credited with inventing the automobile in Germany, but Henry Ford introduced the concept of mass-produced vehicles that were economical for the everyday consumer.
Part I: ACR 2017 Advocacy Essentials and Capitol Hill Day; What You Need to Know
A crucial component to the yearly ACR meeting is advocacy, including the Capitol Hill Day visits. This year, exciting new elements will be unveiled in addition to the traditional programming which has been so effective in our profession’s advocacy efforts.
The ACR Rutherford Fellowship Experience
This past month, I had the opportunity to participate in the American College of Radiology’s J.T. Rutherford-Lavanty Fellowship in Governmental Relations in Washington, DC, during a crucial time in our nation’s history, at the epitome of health care reform.
Staying on Course
As CMS' Quality Payment Program gets underway, radiologists try to reconcile more clerical responsibilities with high-quality patient care.
Asking radiologists what they think of the increased clerical responsibilities inherent in CMS' Quality Payment Program (QPP), the care delivery mechanism of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will yield many colorful answers.
TBD: Radiology's Role in Alternative Payment Models
Radiology must evaluate its role in the rapid evolution to 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.
MACRA and QPP are here. Are you ready to drive change, but don't know how or where to start?
With fast-approaching deadlines, the mandate for transformation to value-based radiology is more urgent than ever before. The trouble is many smaller and mid-sized practices are still struggling with implementing the principles and practices of Imaging 3.0®.
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.
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.
On the journey toward Medicare’s new Quality Payment Program, preparation is half the battle.
The future is now. Ready or not, the era of value-based payment is upon us.
The Highs and Lows of Lung Cancer Screening
All eligible patients should have access to 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.
Connecting the Dots
How incentives under a Medicare alternative payment model might affect radiology practices.
We're in uncharted territory. More than ever before, our health care system is so complex that it is increasingly difficult to foresee the consequences of proposed policies and organizational changes.
Pick Your Pace Under MACRA
The ACR Commission on Economics stands ready to provide tools for radiologists to achieve Quality Payment Program Success.
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.
Want to Get Paid More? Take Some Risk.
The ACR Commission on Economics is evaluating the role of risk in expanding alternative payment models.
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.
The Challenge of Protecting Mammography
The ACR Commission on Economics continues its efforts to maintain the economic viability of mammography services.
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.
Meet the ACR Leadership: Howard Fleishon, MD, FACR, MMM
For this installment, I will be interviewing Howard Fleishon, MD, who is the current Secretary/Treasurer of the ACR. He also serves as the Vice Chair of the Commission on Government Relations.
Unprecedented practice transformation is underway, and radiologists need to get involved.
Now more than ever, patients expect the right care, at the right time, and at a reasonable cost. To reach that goal, health providers must achieve practice transformation on an unprecedented scale.
More than 140,000 clinicians will be transforming their practices over the next four years. The ACR Commission on Economics wants radiology engaged.
"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.
Our Place in the House of Medicine
A recent win for patient care demonstrates the value of banding together with our physician colleagues.
In June, I had the pleasure of attending the AMA annual meeting as a representative of the ACR. Arl Van Moore Jr., MD, FACR, former BOC chair and ACR president, leads the ACR delegation and runs a ship as tight as the submarine on which he served many years ago.
The latest tool from the Neiman Institute provides Medicare benchmark data to help you negotiate bundled payments.
Radiologists do not have to be superstars in data analysis to successfully negotiate bundled payment for services. A new resource developed by the Neiman Health Policy Institute™, ICE-T (Inpatient Cost Evaluation Tool), delivers hard data on inpatient claims collected from Medicare.
Are We Ready for Round Two of ICD-10?
It’s time for every radiology practice to identify its ICD-10 champion.
We survived round one of the ICD-10 implementation. As you've probably heard, ICD-10 is the revised system for diagnosis coding.
Big ICD-10 Challenges Ahead
The transition to ICD-10 codes has been official for the past year, but many challenges lie ahead.
When medical professionals made the switch to the 10th revision of the International Classification of Diseases, 10th revision (ICD-10) last October, the conversion was monumental.
5 Things You Should Know About Value-Based Payment
With the new payment system at hand, there’s a lot of information swirling around for physicians to learn. The Bulletin asked Gregory N. Nicola, new chair of the ACR MACRA Committee, what radiologists need to know about the new payment system.
What’s a PTN and Why Should I Get Involved?
You may have heard (read: you’ve definitely heard unless you live under a rock) about value-based care lately. “Value” is a hard term to nail down, but it’s not just a buzzword.
Is Consolidation the Answer?
The RFS Journal Club debates the pros and cons of one of the biggest trends in health care today.
Despite the Federal Trade Commission’s anti-trust efforts, hospital consolidation continues to grow. Between 2007 and 2012, 835 hospitals were involved in 432 merger-and-acquisition deals, with another 95 occurring in 2014. Sixty percent of hospitals are now part of a larger health care system, and it is predicted that up to 20 percent of all U.S. hospitals will be involved in a merger in the next five years.
Change Is Coming — But the ACR Stands Ready.
Is your practice on board?
In light of the new rules on value-based care, the College is determined to ensure that members realize all the tools and resources available to help them take advantage of the new payment models coming their way.
MACRA: How We Got Here
Learn the ins-and-outs of value-based care.
Take home points:
1. Even agreed-upon legislative reforms take time and political pressure to bring about.
2. The SGR created incentives to “patch” the ill-conceived legislation rather than pay for its repeal.
3. MACRA represents a shift from an old mechanism of payment adjustments to a new value-based paradigm.
Understanding Episodes of Care
The Commission on Economics is working to define radiology’s place in episode groups.
What role does radiology play in clincal care? This is a wide-open question with multiple potential answers.
Catch Your Wave
As alternative payment models emerge, radiologists must find their place in the shifting paradigm.
The tide of health care is turning. On one side is the traditional fee-for-service model, in which radiologists and other physicians are paid according to the number of exams they read and patients they see.
Radiology Advocacy in an Election Year
How do current politics impact radiology?
As you’ve surely noticed, the current election season is in turmoil. Next January we will have a new president and potentially a very different political climate to navigate.
Rounding Up ACR 2016
Here's what you missed
The Bulletin team has loved our time at ACR 2016. Radiologists engaged with patients, partnered with programmers at a hackathon, advocated on the Hill, and learned about the most important topics facing the specialty, among countless other activities. We've rounded up some of the best news from the meeting in case you've missed it. See you next year at ACR 2017!
Hill Day in Photos
On Wednesday, ACR members took their message to the Hill, meeting with their state representatives to advocate for patients in radiology. This year’s issues will have real impacts on patient care in the U.S., and radiologists did their part to secure secure support in Congress.
Capitol Hill Cheat Sheet 2016
All you need to know for Hill Day
On Wednesday, ACR members head to Capitol Hill to discuss issues at the intersection of patient care and legislation. Here are the big issues members raised with their representatives during ACR 2016.
Economics Forum Part 1
Storytelling and branding are important parts of radiology's future.
The importance of storytelling took center stage during part one of Monday’s ACR 2016 Economics Forum as Geraldine B. McGinty, MD, MBA, FACR, kicked off the proceedings by introducing a speaker the likes of whom annual conference attendees don’t often hear from: a marketing guru.
ACR 2016 Council Session
BOC Chair Report: Part of the Care Team
“If you’re in medicine, you’re in politics.”
Economics Forum: The Economy of Care
Patient-centered care was front and center at this year's economic forum.
Part two of Monday’s Economics Forum began with an awards ceremony. William T. Thorwarth Jr., MD, FACR, ACR’s chief executive officer, presented the Thorwarth Award for excellence in economic and health policy to Christopher G. Ullrich, MD, FACR. Thorwarth called Ullrich a “tremendous contributor” to the area of economic policy and to the specialty.
The Lung Cancer Screening Team
Putting together a cohort to develop a screening program requires a mix of skills and a shared purpose.
No specialty can singlehandedly take on the task of screening patients for lung cancer. With that in mind, an ACR 2016 session brought together a multidisciplinary panel to focus on the ins and outs of setting up a lung cancer screening program from a variety of perspectives.
In Case You Missed It
ACR 2016: Sunday, May, 17
Here's what happened yesterday at ACR 2016.
MACRA, MIPS, and APMS: Making Sense of Alphabet Soup
College leaders give a rundown on the new legislation and what to do about it.
At the Crossroads of Radiology, the word “change” is on everyone’s tongues. Driving part of that change is the MACRA legislation, which repealed the much maligned SGR methodology.
The New MACRA Committee
The Commission on Economics goes into operational mode as it approaches new payment models.
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.”
The chair of the Board of Chancellors outlines priorities for the next two years.
As I looked over the attendees of our annual meeting this year, I was seized with a sense of excitement at the prospect of serving as chair of the Board of Chancellors. I am so proud of our organization, our specialty, and our members.
The influx of baby boomers into the Medicare population is causing changes in the health care landscape. But it isn’t all dire.
Baby boomers are the largest generation of Americans ever. Every day, about 10,000 of these individuals turn 65 and become eligible for Medicare. At this rate, the number of Medicare enrollees will increase from 54 million to more than 80 million by 2030.
Getting Some Clarity Around Screening Mammography
In these muddy waters, can we find and fight breast cancer?
Saving lives through mammography does not have to be expensive. In fact, an informed use of current technology allows breast cancer specialists to diagnose and treat the disease better than ever before. Yet recent updates to the United States Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines have muddied the waters, leaving the public, patients, and providers searching for answers in the quest to catch and cure breast cancer.
The Harvey L. Neiman Health Policy Institute® is shaping the future of radiology through evidence-based research.
Abraham Lincoln once said, “The best way to predict your future is to create it.” In today’s dynamic era for radiologists, that is exactly what the Harvey L. Neiman Health Policy Institute® is striving to accomplish.
What’s Next for the Commission on Economics
The College is charting a course for success in a changing world of reimbursement and incentives.
This is my first column as incoming chair of the ACR Commission on Economics.
MACRA: One Year On
MACRA’s first anniversary is upon us. Where are we now?
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.
More Than Theoretical
ACR’s impact on payment policy goes beyond intangible goals and makes a measurable difference for radiologists and their patients.
After an eventful legislative finale for 2015, I’ve been pondering the impact on radiology of the Consolidated Appropriations Act of 2016 (also called the Omnibus Reconciliation Act) enacted by Congress in December 2015. Our influence resulted in the inclusion of the roll back of the professional component Multiple Procedure Payment Reduction policy (MPPR) from 25 percent to 5 percent.
A Resident’s Primer on Radiology Advocacy
My Rutherford Fellowship Experience
I was incredibly fortunate to complete the ACR Rutherford-Lavanty Governmental Relations Fellowship last month in our nation’s capital. The fellowship, established in 1993, was named in honor of the first ACR lobbyist, J.T. Rutherford, and Donald F. Lavanty, ACR’s principle legislative consultant for 42 years.
Beating Back the MPPR
A recent decision from Congress rolls back one of radiology’s most maligned reimbursement cuts.
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).
Meaningful Use to Undergo Changes
CMS is ready to revamp the MU program. What does this mean for radiologists?
The radiology community was all abuzz when CMS Acting Administrator Andy Slavitt indicated in a recent speech that "the Meaningful Use (MU) program...will now be effectively over.” However, don’t make any moves yet — Slavitt later acknowledged on a CMS blog that MACRA requires that the existing MU standards must still be followed, at least in the early years of the Merit-Based Incentive Payment System (MIPS).
New Year's Resolutions: Round 2
What will you do this year to become a better radiologist?
Last month, I challenged each of us to embark on a set of professional resolutions for 2016. Since then, I’ve begun new efforts to make my practice more patient centered. Now I’m launching two more resolutions for the new year. I hope you’ll join me in taking a look at our practices and our specialty and charting a course of constant improvement for ourselves, for our health systems, and especially for our patients.
What Is the ACR Doing About MACRA, MIPS, and APMs?
A Resident’s View
If you’re wondering what the ACR is doing to position radiology for success in the changing health care system, I’ve got an answer for you: A lot.
The Moorefield Fellowship
Melissa Chen, MD, neuroradiology fellow at Baylor College of Medicine in Houston, tells the Bulletin about her time as an ACR Moorefield Fellow, spending time with the economics and government relations departments at ACR HQ.
The ACR legal team tackles the latest medicolegal issues and their effects on radiology.
The ACR’s legal department receives countless calls and emails from members seeking legal guidance and advice. This month, ACR’s legal counsel weighs in on some of the most frequently asked questions about the intersection of radiology and the law.
Keeping Patients at the Forefront
As the health system shifts, radiologists must stay in tune with the needs of their patients.
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.
Why It Matters: the Recent News on the PC MPPR and PALS
Two recent legislative victories made a serious impact on the future of the specialty. Here’s what these events mean for radiologists and their patients.
CMS has postponed the deadline for clinical decision support. But change is coming, and radiologists will be at the forefront.
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.
What's coming for the radiology workforce?
Each year the ACR Commission on Human Resources survey practices far and wide to get a current snaposhot of radiology's work environment and to make projections of the year to come. Check out some of the top findings below.
Economics Tools and Resources
Need help navigating the new, value-based payment landscape? The College has you covered.
Changing Platitudes to Attitudes
MACRA Legislation means the Time for Action is Now.
In November 2014, David C. Levin, MD, FACR, gave the RSNA’s Annual Oration in Diagnostic Radiology. In his address, Dave challenged us all — radiologists and our specialty societies alike — not to let our specialty societies’ value-based initiatives become merely “convenient slogans” for the specialty.
On the Road to Value-Based Care
How can a newly funded CMS grant program position you for success in demonstrating value and making a difference in patient care?
The journey to value-based reimbursement is full of twists and turns, ups and downs. On paper, the map to the future of health care seems simple enough — provide the best possible care for patients and you’ll be rewarded.
Top 5 reasons to contribute to RADPAC before Nov. 1
We are now in the tail end of the 2nd annual RADtoberfest, the largest fundraising event of RADPAC (the ACR’s Political Action Committee). Until Nov. 1, radiologists will compete in divisions based on chapter size. The chapter with the highest number of contributors per state wins! If you have not contributed to RADPAC yet this month, you only have a couple days left. What are you waiting for? Here are the top five reasons you should contribute to RADPAC right now!
Taken to Task
When the USPSTF issued mammography screening draft guidelines, the ACR took action.
Many observational studies have demonstrated the efficacy of women beginning mammography screenings at the age of 40. In addition, organizations such as the ACR and the Society of Breast Imaging have contended that the so-called “downsides” to starting screening at age 40 are overstated. Most instances in which patients may be recalled due to inconclusive findings result in nothing more than another mammogram or ultrasound being performed. Published studies show that anxiety from this process is short lived, has no lasting effects, and pales in comparison to the enormous benefits of catching breast cancer early to reduce mortality.
The Rhode Island Radiology Society gets the state’s outpatient revenue tax overturned.
In June 2007, radiologists in Rhode Island were caught off guard.
Breast Density Update
Where does your state stand?
To date, 24 states have passed some form of dense breast legislation that requires breast density notification or disclosure for patients. An additional four states have provisions that are not direct mandates. Read on to find out the status of your state.
Protecting Women’s Access to Screening Mammography
These members of Congress got it right.
In August, Senators Keely Ayotte (R-NH) and Barbara Mikulski (D-MD) introduced the Protect Access to Lifesaving Screenings (PALS) Act (S. 1926) in the U.S. Senate.
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?
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.
Michael T. Otte, MD
Q: How can you add value to health care through advocacy?
I have little experience or ambition politically but began working in the Colorado Radiologic Society. I received ACR emails and bulletins describing urgent legislation that could be detrimental to our livelihoods. I wasn’t sure how to get involved in influencing the health care system because I did not understand advocacy.
With new payment models throwing health care into transition, now is the time to remember why we became physicians in the first place.
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.
Medicare’s Proposed Rule for 2016
Changes are just around the corner.
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.
3 Things to Read Today
Intriguing links from around the web.
This week we have ICD-10 deadline woes, a primer for the Merit-Based Incentive System (MIPS), and more.
SGR, Radiology, and New Payment Models
Dispatches from the June RFS Journal Club
● Solving The Sustainable Growth Rate Formula Conundrum Continues Steps Toward Cost Savings And Care Improvements presented by Ashley Lotfipour, MD
● Medicare Physician Payment Reform: Securing the Connection Between Value and Payment presented by Travis Fuchs, MD
Value-based payments are coming. How is the ACR positioning radiology for success in this new system?
On April 16, 2015, President Obama signed into law a potentially game-changing piece of legislation related to radiology payment policy.
Radiology in the News
How do we get a more balanced approach to reporting the benefits and risks of medical radiation?
Helping our patients understand the true benefits and risks of radiation exposure has been challenging. The Image Gently® and Image Wisely® campaigns, which the ACR cofounded, have had success in partnering with the media to publicize patient resources such as the top questions patients should ask their providers about prescribed medical imaging exams. Still, most patients are given little information about risks and few avenues to find more substantial answers. So it was an exciting milestone this past March, when radiologyinfo.org, the patient information site ACR co-manages with RSNA, received over one million monthly visitors.
3 Things to Read Today
Intriguing links from around the web.
This week in links we have mammography standoffs on Capitol Hill, news on AHRQ, and more.
ACR Capitol Hill Day: A Resident’s Experience
As ACR members headed to the yearly advocacy event, one of the College’s newest physicians reports back on an eventful day in Washington, D.C.
On a hot Wednesday in May, more than 630 radiologists from across the country visited the congressional offices of more than 290 members of Congress.
How Can I Help?
Opportunities for International Outreach and Involvement from the ACR RFS International Outreach Subcommittee
The ACR RFS International Outreach Subcommittee is a young and active group. Our aim is to be the primary resource for residents and fellows seeking information about global health imaging opportunities.
In Case You Missed It
ACR 2015 Hill Day
On Wednesday, hundreds of radiologists headed to Capitol Hill as part of ACR 2015. Attendees met with their members of Congress to advocate for the specialty and educate legislators about patient care. Here's what members told us and tweeted during the action-packed day on the Hill.
Capitol Hill Cheat Sheet 2015
Find out the big issues members raised with their representatives during ACR 2015.
On Wednesday, ACR members head to Capitol Hill to discuss issues at the intersection of patient care and legislation. Here’s a cheat sheet explaining what radiologists are paying attention to on Capitol Hill.
Waiting to Exhale
CMS officially announced its coverage of lung cancer screening in February. How did we get here?
Like a lot of stories, this one starts with a prologue, some background to remind us where we’ve been and how far we’ve come.
Preparing Radiologists for the Future
How is the College supporting radiologists entering new payment structures?
In a recent article in the New England Journal of Medicine, Health and Human Services (HHS) Secretary Sylvia Burwell wrote that by 2016 she expects 85 percent of payments in the Medicare program, including those within the fee-for-service system, will have a link to quality or value.
Connecting With Legislators
Interested in hosting a visit from your member of Congress? One Hawaii practice tells its story.
In this era of health care reform, radiologists must demonstrate value to a variety of audiences. To communicate with patients, it might mean seeking out face-to-face interaction and clarifying the role of the specialty. With other physicians, it could mean discussing critical results and joining hospital committees. But what about policy-makers?
Dreaming the Impossible
How can radiologists look past the current difficulties in their specialty?
In the musical play Man of La Mancha, the delusional idealist Don Quixote is asked why he does the ridiculous things he does. Before breaking into the iconic song “The Impossible Dream,” he responds simply, “I come in a world of iron … to make a world of gold.”1
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
3 Things to Read Today
Intriguing links from around the web
This week in links we have Congressional reaction to the USPSTF’s updated breast screening recommendations, how exposure to reading prior to kindergarten might impact how a child’s brain processes stories, and how HHS and Congress plan to collaborate in fixing EHR issues.
Practices must identify reasons for non-payment and find ways to capture revenue.
Claim denials can be a major source of frustration for physicians and their practice managers and can have a real impact on cash flow and the financial performance of a practice.
David T. Boyd, MD, MBA
Q: How can state chapters work together with the ACR?
Engaging residents and fellows in radiology leadership is an important goal for the Washington, D.C., chapter
Lung Cancer Screening Update
As this valuable coverage rolls out to patients, the Commission on Economics works to tie up loose ends with CMS.
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.
5 Radiology Stats That Might Surprise You
The latest tool from the Harvey Neiman Health Policy Institute™ is a must-see for radiologists.
The latest tool from the Harvey L. Neiman Health Policy Institute™ lets users create easy-to-read graphs and maps from a huge selection of radiology-focused data.
Advocacy, Economics, and Health Policy Pathway
Prep for sessions in this pathway by browsing the following resources. Find out more about payment policy basics, maximizing performance and revenue in both volume- and value-based payment settings, as well as the work of the Commission on Economics.
Patients and Pricing
Educating our patients about the true costs of imaging reaps benefits throughout the health care system.
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.
The population of patients insured with marketplace health plans is growing — and with it comes a new set of challenges for radiologists.
Under the Affordable Care Act, over 7.1 million individuals have successfully enrolled in and paid for plans under the health care marketplace.
Answer these questions to uncover your superpower and conquer your kryptonite.
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'?"
A Win for Our Patients and Our Communities
The journey to obtain Medicare coverage for lung cancer screening with low-dose CT
Any new practice innovation is a journey that begins with solid scientific research. The new ACR Strategic Plan emphasizes our commitment to innovation in one of the five goal areas: “Innovation and Research: From Science to Practice and Policy.” However, in the era of health reform, innovation alone will not be enough. We have to do much more than show a new innovation is safe and effective; we also have to demonstrate that it improves outcomes and can be delivered at a reasonable cost.
Supporting Those Who Support Us
My election day experience
On Election Day morning, I set out with Ted Burnes of RADPAC along with two of Senator Pat Roberts' staffers to go door-to-door, encouraging people to vote. Senator Roberts has been an important advocate for radiology legislation in Congress, joining more than 40 senators to sign for support of low dose computed tomography lung cancer screening.
Your Voice in Washington
The Commission on government Relations unites the specialty to advocate for the future of radiology.
The ACR Commission on government relations (GR), working with our Washington, D.C. staff, is charged with representing to Congress and legislators the interests of our patients, members, and those who contribute to the entire radiology profession.
Out with the Old, in With the New?
The 2015 Final Rules hint at what's to come in the year ahead.
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.
Naughty or Nice
Which list will CMS be on this holiday season?
Performance-based incentives are nothing new and are certainly not unique to health care.
The place for professional networking
As part of the strategic planning process for the College, I have been thinking a lot about why radiologists would want to be members of professional organizations.
Liaison Outreach and Development of ACR Policy
CSC members focus on their primary roles and welcome member involvement.
During the summer and fall, the Council Steering Committee (CSC) has expended a significant amount of effort to support its mission and engage in both liaison work and the development of policy resolutions.
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?
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.
Appeals of ACR Accreditation Decisions
What are my options if my facility does not receive accreditation?
The stakes for ACR members and their practices have risen dramatically, particularly in relation to accreditation. As of January 1, 2012, CMS began requiring accreditation from designated organizations such as the ACR for suppliers that furnish the technical component of advanced diagnostic imaging services in a non-hospital setting.
Protecting Our Smallest Patients
The Commission on Pediatric Radiology advocates for its patients and advances the subspecialty.
The commission encompasses committees on Quality and Safety, Education, Economics, Advocacy, and Research.
RADPAC's crystal anniversary marks 15 years of political engagement.
RADPAC, the American College of Radiology Association (ACRA) bipartisan political action committee (PAC), is celebrating its crystal anniversary this year.
Radiologists take on the evolving health care paradigm with inspiration from the corporate world.
Professionals in business and medicine make difficult decisions on a daily basis, prioritizing the customer’s (or patient’s) needs through exceptional service. So it’s no surprise that radiologists are seeking advice from successful entrepreneurs.
The OIG Work Plan
What are the HHS areas of focus this year?
In past columns, we outlined the history, authority, and structure of the Office of the Inspector General (OIG) of the federal Department of Health and Human Services (read more at http://bit.ly/May12RADLAW) and explained the OIG Advisory Opinion process (read more at http://bit.ly/June12RADLAW).
The Story Behind the SGR Fix
How ACR advocacy influenced policy and protected members and patients in the most divisive Congress in decades.
You already know how this story ends. But in a lot of ways, it starts on New Year's Eve 2012.
Bundling up...In August?
The ACR economics team is focused on positioning radiologists to thrive in both existing and emerging payment models.
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.
Aligning Incentives in Health Care
The recent SGR legislation brings us one step closer to a blueprint that works for stakeholders throughout the health care system.
In March of this year, I had the pleasure of attending the Oklahoma Radiological Society Meeting. We had a great discussion with radiologists about issues facing their practices and how the College was advocating in Washington on their behalf.
Heading to the Hill
Radiologists from the ACR Association take their message to Congress to build connections and advocate on the specialty's behalf.
More than 500 ACR members visited about 250 congressional offices to thank their senators and representatives for recent legislative success and to solicit support for a Medicare benefit covering low-dose CT lung cancer screening.
Future by Design
Imaging 3.0™ and the future of the profession dominate the economics session of AMCLC.
As part of Tuesday's AMCLC programming, ACR leadership presented the economics program and armed members with the tools to thrive in the changing health care environment.
Working with an outdated OS could cost you more than just an upgrade.
Isn’t technology always — or virtually always — ahead of the law? Frequently, yes. Courts and administrative agencies regularly decide cases in which a technological solution presents a unique legal issue.
Get to Know Your CFO
Establishing relationships with leaders in your health system can be beneficial for both your department and your patients.
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.
What Lies Beneath
Relative value units are an intrinsic part of tracking physician payment and productivity but do they show the whole picture?
Take a moment and think back to when you were in middle school. You took a whole spectrum of subjuects, from English to gym. When you received your report card, your grades were predictably based on criteria individualized for each subject — in English, it was the papers you wrote or the vocabulary tests you took. In gym, it may have been how fast you could run a mile.
A Commitment to Doing It Right
The ACR advocates to bring lung cancer screening to patients in need.
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.
Accounting for Quality
A Maine-based accountable care organization ensures quality and lower costs.
Fear of the unknown: It’s a phenomenon we all experience. This trepidation is well exemplified by health professionals approaching the uncharted waters of accountable care organizations (ACOs).
The Business of Billing
Evaluating managed care companies and their payment practices.
In the ever changing world of imaging providers, gone are the days of maximizing volume to make up for low reimbursement rates. A once straightforward business process is now a complex set of possibilities.
7 Essential Elements of an Effective Compliance Program
For those of us in the business of radiology practice leadership, compliance with government laws and regulations is a major component of what we do. In fact, radiology is probably one of the most heavily regulated medical specialties.
Your practice's billing data can help you improve patient care and manage your practice. Here's how to extract this valuable information and make connections across disparate datasets.
It is an eat-or-beeaten world out there as radiology practices search for the winning formula of services, systems, and practices to survive in a volatile marketplace.
The Price is Right
A comparison of out-of-pocket costs reveals the complexities of imaging pricing.
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.
Q: Value is a hot topic in radiology right now. What does the term mean to you?
The value a radiologist adds to the medical team became apparent to me early in my medical school days.
Health Insurance Exchanges
As the ACA rollout continues, what should you know about the disputes and litigation?
First you have the problem and then you have the litigation. This more-or-less iron rule of American life will be honored once again in the aftermath of the rollout of Obamacare.
Avoid Getting Burned by the Sunshine Act
You've probably heard of the Sunshine Act, but do you know what it means for radiologists?
Does learning more about the Sunshine Act feature on your to-do list? Although the act does not require physicians to actually do anything, ignorance about its implications can have serious consequences.
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.
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.
Preparing for the Future
The RFS Journal Club brings together members-in-training to learn about radiology economics now and going forward.
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.
What to expect and where to turn when your hospital sends out a request for proposals.
If losing a hospital contract is like going through a divorce (an apt metaphor according to many who’ve been in this situation), then having your hospital send out a request for proposals (RFP) is similar to your significant other posting an ad on an online dating site. The emotions are all there: shock, disbelief, and betrayal.
Do Wrong to None
In this new era of value-based health care, radiologists believe that reporting errors will bolster patient trust.
"Deny and defend.” For many years, this was the credo of risk managers, quality improvement experts, and radiologists alike when an error was committed during the course of a patient’s care.
As 2013 comes to an end, have we met our goals?
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?
As we await decisions on CMS policies, radiologists wonder what will be on the table this holiday season.
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?
Don't Just Fight the Law, Change It!
Radiologists have learned to use the legislative system to counteract unfair court rulings.
In the July 2013 Bulletin column entitled "If You Fought the Law," we discussed how and why the College decided not to bring a lawsuit against the federal government over the method and information used to justify reductions in reimbursement for some types of medical imaging.
A Haunting Proposition
Radiologists who ignore programs designed to help them transition from volume- to value-based care do so at their own peril; here are four areas to look out for in the coming year.
The Danish philosopher Søren Kierkegaard once said, "There are two ways to be fooled. One is to believe what isn't true; the other is to refuse to believe what is." Never has this saying been more accurate than when applied to the way some physicians have reacted to changes occurring in medicine.
Radiologists nationwide breathe life into Imaging 3.0™.
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?
Another Challenge Lurks in the Affordable Care Act
What do you need to know about state insurance exchanges?
Time can fly, even when it comes to the law. Over three years have passed since President Obama signed the massive Patient Protection and Affordable Care Act, aka the health reform law.
Bending the Cost Curve
The state of Arkansas implements a new payment initiative designed to incentivize individual providers to improve efficiency without compromising quality.
Health-care expenditures in the United States increased tenfold between 1980 and 2010 and continue to rise. As a result, states across the nation are seeking solutions for controlling health-care costs without compromising care.
Back to School
While many individuals have filled the past few months with summer fun, the ACR has been busy innovating.
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.
Understanding the specifics of how antitrust relates to physicians.
The ACR Legal Office continues to receive questions about why federal and state authorities seem more concerned about doctors violating antitrust laws and less concerned about hospitals and insurance companies doing so.
Now is the time to begin participating in PQRS to avoid penalties in 2015 and beyond.
Editor's Note: In this age of profound changes in health care delivery models, radiologists must find new strategies to stay viable. One such approach is called Imaging 3.0, an initiative by the ACR to shift the culture of radiology. Imaging 3.0 promotes a change from focusing on the volume of scans read to the value of the patient experience, provides measures that assure quality and safety, requires coordination and collaboration among physicians and patients, and empowers patients in their imaging care.
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.
July 4th is a great American holiday. As a naturalized citizen, I love everything about Independence Day, from the national anthem to the fireworks.
If You Fought the Law
Suing the HHS over payment reductions probably wouldn't work in view of its close ties to Congress.
Members often ask why the College doesn't simply sue the government when Congress, the Department of Health and Human Services (HHS), or its subcomponent, the CMS, does something that harms radiology.
A Day on the Hill
Radiologists from the ACR Association take their message to Congress to advocate on the specialty's behalf.
On Monday, May 6, AMCLC attendees began their advocacy training. During the meeting, Congressman Tom Price, MD (R-Ga.), a member of the Committee on Ways and Means, spoke in detail about the legislative prospects for the Multiple Procedure Payment Reduction (MPPR) bill (HR 846/S 623) as well as the process for reforming the Sustainable Growth Rate (SGR) formula this year.
An Age of Opportunity
Speakers during the economics session emphasized the need to transition from volume- to value-based health care.
As part of Tuesday's program, the Economics Forum included a discussion of future opportunities for radiology, including the transition to compensation driven by performance rather than productivity.
Adapting to Change
In a time of declining reimbursements and increasing government regulations, radiologists evolve to remain integral members of the health-care community.
No one remembers Camarasaurus. At 75 feet long and weighing 50 tons, the dinosaur thrived during the late Jurassic Period.
A Jolly Good Fellow
The College's collective voice is a powerful and influential tool.
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."
Radiology's Unlucky Number
Understanding the story behind CPT® Code 73721 and what it means for the future medical reimbursement.
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.
A Tale of Two Radiologists
Let's take advantage of the incentives we have before we lose them.
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
A Fiscal Cliffhanger
Don't let political shenanigans distract you from what's truly important — your patients.
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.
OIG won't penalize practices offering free pre-authorization of patients' behalf.
Does a radiology practice violate the law if it obtains an insurer's pre-authorization of an imaging study on behalf of referring physicians and patients? In a scenario that one group posed, the U.S. Department of Health and Human Services' Office in Inspector General (OIG) recently came back with a verdict: no.
Revealing a Personal Face of Radiology
A new task force sets out to explore the clinical practice of interventional radiology and interventional neuroradiology and advocate for these vital subspecialties.
Mrs. Smith was in dire straits. She was bleeding to death during her C-section. Her experienced OB thought she might not survive a hysterectomy and asked for my help.
The Rutherford Experience
Radiology chief resident spends a week embedded in government relations.
During the fall of 2011, radiology resident Bhavya Rehani, MD, spent a week with the ACR Government Relations Department in Washington, D.C., as the J.T. Rutherford Government Relations Fellow. The fellowship is named in honor of the first ACR lobbyist and was founded in 1993 to give radiology residents a better understanding of government's role in radiology.
More or Less
The Inaugural Policy brief of the Harvey L. Neiman Health Policy Institute reports that the use of medical imaging has declined in recent years.
Clinical utility, financial conflict of interest, physician fear of medical malpractice: these are few factors that drove up medical imaging expenditures in the early part of the last decade.
This year let's set some goals that will benefit our patients, our practices, and our specialty.
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.
Reasonable and Necessary
What does it mean and who decides?
Federal Medicare law states, "No payment may be made under part A or part B for any expenses incurred for items or services which ... are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."1
Challenging ourselves to meet the service expectations of our patients.
I came across an opinion article in the New England Journal of Medicine that I thought had some valuable lessons for radiologists.
The ACR Takes on Antitrust
Protect yourself and your practice by becoming familiar with ACR's official policy.
Last month's column explained key antitrust laws and why the matter to ACR members. This month, we offer ACR's Antitrust Compliance Policy, which has been adopted by the ACR BOC. The policy applies to ACR members, staff, and the conduct of ACR meetings and other ACR activities.
What Constitutes a Session?
"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.
In Law We Antitrust
Should radiologists be concerned about antitrust laws?
Occasionally, someone calls the ACR Legal Office with an antitrust question. Usually, the member or group has tried to take an action and has been told simply that it cannot be done as it would violate antitrust law, but isn't provided with further explanation.
Becoming Decision Makers
Two radiologists play integral roles in Michigan's Certificate of Need program.
Regulating health-care cost, quality, and access are the three main objectives of the Michigan Certificate of Need (CON) Commission. But it can be difficult to balance such distinct and sometimes conflicting facets of our health-care system.
Taking Back Imaging
Can radiologists keep imaging decisions within the specialty without interference from RBMs?
Many payers may see radiology benefits management (RBM) companies which analyze the appropriateness of high-tech imaging procedures, as tools to keep their costs down.
Déjà Vu All Over Again
When you work at Montefiore Medical Center in the Bronx you pretty much have to be a Yankee fan.
It's more than just a business model.
In this column, we will examine an issue that has energized — and divided — radiology and the ACR: teleradiology.
ACR members demonstrate the importance of radiology to the government and the public.
ACR members are up against significant challenges that cannot be resolved by the efforts of a single individual. But by working together and being engaged, the College moves legislative mountains and continues to fight organizations seeking to reduce Medicare reimbursements to radiologists.
One 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.
ACR Goes to Washington
College members visit Congress to advocate for radiology's best interests.
On Wednesday, April 25, more than 400 radiologists visited approximately 300 congressional offices on Capitol Hill.
Speakers urge members to highlight radiology's relevancy and mitigate uncritical imaging.
As part of Tuesday's program, the economic session included a discussion of the threats to radiology, such as reductions in reimbursement and legislation that could drastically impact the practice of radiology, as well as the successes of the ACR's efforts — both small and large.
Who Is the IG and Why Should I Care?
ACR members have a vested interest in the decisions and positions taken by the Inspector General.
In the medical world, IG is the abbreviation for the Inspector General of the U.S. Department of Health and Human Services (HHS). Radiologists should be concerned with and understand the role of the IG because he or she has immense power and influence in the medical payment world.
Turning Dollars Into Actions
Chapter president shares secrets to fundraising and member communications.
Much of the College's power to advocate for the specialty depends on its state chapters' commitment to advocacy. After all, local issues in radiology are as equally important as those at the national level.
Successful Medicaid Battle in Vermont
One state chapter mobilizes against reimbursement cuts.
The Vermont Radiological Society (VRS) was alarmed late last year when the Department of Vermont Health Access (DVHA), which had already cut Medicaid reimbursement for diagnostic imaging services by 25 percent, then proposed an additional 21-percent cut in reimbursement for 2012. This proposal coincided with end-of-year holidays, leaving only a short window for submission of formal comments.
Prepare for a possible medical group audit with a review of the recovery audit program.
For nearly a decade, CMS has been developing a new weapon in its arsenal against fraudulent, duplicate, and incorrect claims: medical group audits.
Taking 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.
What's New in Supervision?
Violate imaging supervision rules, and you may lose the change to participate in Medicare.
Editor's note: This is the conclusion of a two-part series addressing the controversial subject of medical imaging supervision. The first article (http://bit.ly/RADLAWApr2012) summarized related Medicare rules.
Preparing For Transitions
The work of the Commission on Economics is one of several major ways we provide value to its members and our specialty.
10 Steps to Meaningful Use
A strategic approach helps radiologists tackle the government's incentive program.
By now, most health-care professionals have at least a basic understanding of Meaningful Use (MU) — the government program that provides incentives for the implementation and appropriate use of certified electronic health record (EHR) technology — and the impact it has on modern health-care practice.
Comparative effectiveness research shifts into high gear, but can radiology find its place?
Does your patient have a life worth living? That's one of the many questions that comparative effectiveness research (CER) endeavors to answer, according to Constantine Gatsonis, Ph.D., professor of Biostatistics and Applied Mathematics at Brown University in Providence, R.I.
Q: Tell us about a time you advocated for the specialty.
Recently, I had the opportunity to convey — in person — this important message to Representative Gregg Harper (R-Miss.): Radiology is significantly improving our patients' lives.
What's new in supervision? Fines, legal expenses, and exclusion from Medicare.
Editor's Note: This is the first of a two-part article about the supervision of medical imaging. The second part will appear in the April 2012 issue of the ACR Bulletin.
Modest victories over Medicare’s irrational payment policies could pay off in the future.
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.
Point, Counterpoint, Recommendations, and Action
In January, I reported the news from the October Board of Chancellors meeting, and I outlined the elements of discussion contained in three point-counterpoint sessions, on RBMs, self-referral, and our identity as radiologists.
Avoid Getting Burned
Affordable Care Act provisions publicize special business relationships and payments.
ACR members should pay attention to part of the Affordable Care Act health reform law that includes "sunshine provisions" for payments and other value transfers received from pharmaceutical and medical device companies.
Finding Ways to Demonstrate Value
New committee promotes and coordinates efforts to measure the importance of imaging.
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).
The Riddle of Self-Referral
Take a peek at what's in store for self-referral in medical imaging.
Most radiologists have an understanding of self-referral and its negative impact on medical imaging and interpretation in the United States.
Speaking Up for Imaging
New national poll results show Americans don't want further cuts to medical imaging.
The field of imaging has been a favorite target for policymakers in recent years. So, when deficit-reduction talks began on Capitol Hill last summer, the ACR took action against further Medicare imaging cuts.
Continuing the Fight
CMS finalizes 25 percent professional component multiple procedure payment reduction.
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.
Should economic-credentialing policies leave radiologists out in the cold? Many hospitals — and courts — say 'yes.'
A recent court decision has raised visibility of the legal and ethical debate about economic credentialing.
CMS Finalizes Payment Reductions
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.
Relief Within Reach
Bringing imaging to medically underserved populations doesn't always require a passport.
The World Health Organization (WHO) reports that the "majority of the world's population is denied adequate access to safe and appropriate medical devices." However, many don't realize that these underserved communities are not limited to developing nations — they can be just miles away.
On Solid Ground
The College maintains a strong position during a tough financial year.
As the economy slowly but surely climbs its way to higher ground, the College's finances have also steadily improved. According to the 2009-2010 financial report from ACR Secretary-Treasurer Anne C. Roberts, M.D., FACR, in Fiscal Year 2010, the College maintained a strong financial position.
The Congressional Forecast for Radiology
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.
Protecting Your Peer-Review Rights
ACR's Counsel elaborate on legal issues within the federal and local peer-review processes.
The ACR General Counsel's Office and the Quality and Safety Department are often asked whether RADPEER™ materials can be subpoenaed or "discovered" in court. As with most legal matters, the answer is more complicated than a simple "yes" or "no."