The Moorefield Fellowship Experience
This past October, I was honored to participate in the American College of Radiology Moorefield Fellowship in Economics and Health Policy.
The two week-long fellowship is named after James M. Moorefield, MD, who served on the ACR Commission on Economics and was instrumental in the college’s work on the relative value scale in securing radiology’s future. Much as Dr. Moorefield advocated for the value of radiologist’s work, the Economics and Health Policy Department continues to promote the importance of radiologists in patient care and society.
The goal of the two weeks spent at the ACR headquarters with the Economics and Health Policy Department is to introduce radiology residents and fellows to the vital work of understanding, developing, and promoting policies that pertain to coverage of diagnostic and interventional imaging procedures, as well as radiologist reimbursement. The Economics and Health Policy Department coordinates its efforts with the ACR Governmental Relations group, along with other non-College stakeholders such as radiology groups that share a common interest in maintaining the radiologist’s key role in promoting patient care.
Most of these efforts go largely unnoticed by most radiologists, even though they have some of the greatest impact on deciding whether patients can have a study paid for by Medicare or covered by private insurance, how the radiologist or radiology practice is reimbursed for providing a service, and what additional steps a radiologist needs to take to receive this reimbursement.
Much of the early portions of the Moorefield fellowship involves delving into the unique worlds of economics and health policy, each with their own language and fundamental concepts to learn. Even though the average radiology resident or fellow has had only a cursory introduction to these disciplines, the ACR staff was able to explain these concepts clearly in such a way that I felt I truly grasped the challenges the Economics and Health Policy Department faces. There is even an acronym key to list all of the governmental programs, legislation, and regulations that the department deals with on a daily basis. Within these two short weeks, I began to think in acronyms ranging from APMs to the USPSTF, and begin to get a sense of why each of these things matter to all radiologists.
Through the Moorefield fellowship, I had the chance to meet with many of the tireless staff working behind the scenes. These analysts work on numerous facets of health policy including answering ACR members’ phone calls, which range from things such as why a reimbursement was denied by an insurer to prevent unnecessary denials in the future. The Economics staff sifts through hundreds of pages of proposed governmental regulations to understand how radiologists might be affected by changes, then respond on behalf of radiologists, and discuss with representatives of governmental agencies such as CMS to communicate the ACR’s position. If I learned only one thing during my brief time at the ACR, it is that there a great many talented individuals working at the College to promote the work that radiologists do so that radiologists can continue to take care of patients effectively.
I also had the chance to learn about how a new diagnostic examination or therapeutic procedure goes through the process of having a Current Procedural Terminology (CPT) code created in collaboration with the American Medical Association (AMA) so that providers can bill private or public insurance for the study. In a similar process, studies with CPT codes can undergo the complex process of resource-based relative value scale update committee, or RUC, to determine how much CMS and other payers will pay for a particular procedure or imaging study to be performed.
During my brief time at the ACR headquarters, I was fortunate enough to be present during the release of the final rule for the new CMS Quality Payment Program issued under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repealed the sustainable growth rate requirement of Medicare that would cut physician reimbursement if not for temporary fixes passed by Congress for the past several years. In addition, this legislation set forth new ways of assessing provider performance to provide incentives for quality care. In reviewing this extensive rule (over 800 pages in final print), I had the chance to work with many ACR staff. Each one had individual expertise in understanding the rule and creating a summary that would effectively explain how the rule affects radiologists specifically.
While the health policy arena is constantly changing with each new government administration, my experience as a Moorefield fellow has made it clear that the ACR is constantly working on behalf of its members to promote the work that radiologists do for patients every day. It is important that as radiologists, whether in-training or practicing, we learn more about how these policy matters affect us. It is just as important that we work alongside the ACR in making it clear how much the work radiologists do matters to ensure that patients have adequate access to imaging to improve their care and that high-quality work is rewarded.
By Andrew J. Degnan, MD, MPhil