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.
She went on to estimate that by 2018, 90 percent of Medicare payments will be value-based. Furthermore, she stated the HHS target for shifting care away from fee-for-service is to have 30 percent of reimbursements occurring within alternate payment models in 2016 and 50 percent in 2018. These alternate payment models (such as accountable care organizations or bundled payment arrangements for episodes of care) are designed to make health care providers accountable for both the quality and cost of the services they deliver to patients. Secretary Burwell went on to indicate that in order to drive progress toward these goals, HHS intends to provide incentives for delivering higher-value care, foster integration and coordination of care within institutions with emphasis on population health, and use IT to provide access to information so that physicians and patients can make better-informed choices.1
How radiologists will be affected by these changes and what the College is doing to prepare us for the future. Making sure radiologists have the ability to demonstrate their value to the Medicare system and other payers is the basis of the majority of the ACR’s strategic plan. It is central to our Imaging 3.0™ initiative and will be a major focus of this month’s ACR 2015 annual meeting. The ACR Commission on Economics has been working to ensure radiologists are well positioned to promote the value we bring to health care delivery. Secretary Burwell’s promoted by HHS, the agency also realizes that at least 50 percent of Medicare payments will remain in the fee-for-service system in 2018. So being able to thrive in a pay-for-value system will be important even for radiologists not participating in alternative payment models.
One of the College’s goals is to increase radiologist participation in current Medicare pay-for-value programs such as the Physician Quality Reporting System (PQRS) by making PQRS reporting easier and more meaningful. CMS recently designated our ACR National Radiology Data Registry (NRDR). Data can be collected automatically throughout our daily workflow and transmitted to document a radiologist’s commitment to radiation safety and other quality metrics. The ACR has also positioned itself to be a leader in influencing the metrics-development process. Participating in quality reporting will be enhanced if radiologists perceive that the metrics will actually make a difference rather than just being another hoop to jump through. To that end, our physician volunteers and staff are working on developing relevant PQRS metrics that can be used in the future. Additionally, the ACR is strengthening our registries to automatically collect, house, and benchmark data from our practices.
Making sure radiologists have the ability to demonstrate their value to the Medicare system and other payers is the basis of the majority ofthe ACR's strategic plan.
The College began preparing for the inevitable increase in alternate payment models more than five years ago. We have been developing tools that will assist radiologists in determining how to set up contracts with payers and integrated physician groups in risk-sharing models such as bundled episodes of care or in the management of imaging services for populations of patients. Recently, the Neiman Health Policy Institute™ developed a database defining radiology’s professional payments associated with Medicare Diagnostic Related Groups for inpatient episodes of care. For each of these groups, the institute determined the associated fee-for-service professional payments to radiologists, stratified by state. This database will be very useful to radiologists if they are asked to participate and contract in a bundled episode such as heart failure or hip replacement. Meanwhile, for radiologists participating in ACOs, the payment structure may look a lot like capitation. The ACR Managed Care Committee and RBMA have recently updated the ACR RBMA Capitation Handbook as a guide for radiologists developing shared risk contracts. Additionally, the Neiman Health Policy Institute has created a database showing total radiology spending and volumes by state so that radiologists can understand local variation.
These are just a few of the tools the College has been developing to help radiologists transition to a value-based payment system. At the expanded ACR 2015 annual meeting, attendees will have an opportunity to engage with experts on how to make the changes in our practices that will allow our specialty to deliver higher value care and thrive under value-based payments and alternative payment models. I look forward to seeing you in Washington.
1. Burwell SM. Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care. N Engl J Med 2015; 372:897–899.
By Bibb Allen Jr., MD, FACR, Chair