A Horse of a Different Color

Imaging 3.0TM leaders reflect on physician payment reform and its effects on radiology.

Horse Smaller

May 2015

Henry Ford had a famous saying: "If I'd asked my customers what they wanted, they would have said faster horses.” Ford was referring to Model Ts, but he may as well have been talking about radiology.

During the Tuesday session at ACR 2015 titled “New Payment Systems and Strategies to Cope: Imaging 3.0™ and Other Initiatives,” Bibb Allen Jr., MD, FACR, chair of the ACR Board of Chancellors, outlined the reasons radiologists must resist the temptation to read an ever increasing caseload to keep pace with reimbursement cuts.

Ensuring the future value of radiology, argued Allen, will require radiologists to become innovative. Allen identified several areas of opportunity for imaging experts, among them the fact that radiologists must assert themselves and define the specialty’s value proposition before politicians and governmental bodies set radiology’s value within the health care system. To accomplish these goals, said Allen, radiologists will have to overcome several barriers. Chief among these obstacles are the trend toward declining reimbursements and the potential for radiologists to become commoditized and thereby irrelevant.

A transition of this magnitude is daunting, however, so it helps to know that others have trod the Imaging 3.0 path. Giving real-world examples of radiologists who have taken to heart Allen’s call to action, Geraldine B. McGinty, MD, MBA, FACR, chair of the ACR Commission on Economics, presented several Imaging 3.0 case studies that lend credence to the idea that imaging experts do not need to wait for someone else to define value for them.

The subject of one of these case studies is Samir B. Patel, MD, a diagnostic radiologist at Radiology, Inc. in Mishawaka, Ind. and a member of ACR’s Value Based Payment Committee. A few years ago, Patel found himself in a bind. During contract negotiations with one of the hospitals his practice serves, the hospital president informed him that the physician leadership had taken a somewhat adversarial position: if Patel’s group didn’t want to “play ball” and accept the hospital’s terms, the president should sever the relationship with Patel’s practice. From the clinicians’ perspective, all radiologists do is read images and, for that reason, would be easy to replace.

Instead of becoming frustrated, Patel put his energy into spearheading an effort to collect all non-reimbursable, non-RVU-based actions performed for the benefit of the hospitals. The result was the “Radiology Value-Added Matrix,” a document that captures quantified value-added actions ranging from the development of protocols to participation in peer review, duties that many radiologists do not typically account for in any concrete way but are, nonetheless, vital to providing quality patient care. The matrix proved that the radiologists at Radiology, Inc. were providing one of their client hospitals close to half a million dollars in added value for which they were not directly reimbursed. This effort so impressed the hospital leadership and Patel’s physician colleagues that he was recently elected to the hospital’s board.

Where some radiologists may see themselves in a hopeless situation, victims of health care reform legislation that demands they demonstrate their value even as the health system seems geared to benefit primary care physicians, others see an opportunity. As McGinty pointed out, despite the fact that reform laws do often marginalize specialists, entities like CMS are nonetheless looking for radiologists to provide them with payment models that reflect what radiologists find meaningful. So there’s really only one question radiologists should be asking themselves at this pivotal moment in history: will you work to become a faster horse, or will you transcend what is to discover what might one day be?

By Chris Hobson, Imaging 3.0 content manager

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