Constructing a Game Plan
Strategy was front and center at the BOC winter meeting.
The ACR Board of Chancellors and Council Steering Committee conducted their winter meeting Jan. 17–18, 2015, in Reston, Va.
In the fall of 2014, the BOC approved the ACR Strategic Plan to assure that future activities are aligned with the College's mission, goals, and objectives. Implementation of the plan began in earnest with a College-wide program assessment. This process was governed by three major assumptions: 1) there are more opportunities than resources; 2) the organization should avoid duplication of efforts; and 3) a few high-level programs meeting widespread needs are a better investment than many programs with low projected utilization. More than 300 ACR programs across 51 areas were reviewed based on program attractiveness, competitive positioning, and alternative coverage. From there, the implementation phase will begin this spring with the consideration of the FY 2016 budget. During the budgeting process we will begin aligning resources to ensure the College is moving toward the strategic goals and objectives over a three- to five-year horizon.
The ACR, along with other key stakeholders, was successful in securing low-dose CT lung cancer screening coverage for high-risk Medicare patients. ACR leaders supporting the Economics, Government Relations, and Public Relations departments saw their diligence rewarded with last week's National Coverage Decision. While efforts to bring lung cancer screening to patients continue, this success of the ACR team cannot be understated.
Cynthia Moran, executive vice president of ACR government relations, provided an update on the November elections, noting that Congress has undergone significant partisan shifts since the fall BOC meeting. The Senate has switched from a Democrat to Republican majority, thus giving the Republicans control (but not veto override strength) in the Congress. She also stated that it may be difficult to duplicate the significant legislative accomplishments of the College in 2014, including victories on clinical decision support, provisions limiting physician payment reductions to a maximum of 20 percent in a one-year period starting in 2017, and a mandate that CMS disclose the data behind the multiple procedure payment reduction. Moran predicted that although Congress will likely engage in initial efforts to repeal the Affordable Care Act, adjustments to the current law are more likely, such as a revised definition of full-time workers, a narrower employer mandate, a possible repeal or delay in the device tax, and a reduction in funding for the Independent Payment Advisory Board. The 2016 presidential election has the potential to impact legislative activity significantly by underscoring the partisan divide that has taken hold over the last few years.
The board also reviewed recent decision support activities and future Imaging 3.0™ initiatives designed to help radiologists take an active role in patient care and help shape America's future health care system. Geraldine B. McGinty, MD, MBA, FACR, provided a report on a pilot Imaging 3.0 Practice Visitation Program, which would allow leaders to analyze critical characteristics of their practices and integrate concrete strategies into their practice culture. Imaging 3.0 aims to provide better value and outcomes to patients in five key areas: imaging appropriateness, quality, safety, efficiency, and satisfaction. The College continues to increase the number of resources on patient-centered care, quality metrics, and health reform to help practices to best position themselves for the future.
Keith J. Dreyer, DO, PhD, FACR, gave an informatics update covering meaningful use, clinical decision support legislation, future federal programs, and an overview of recent activities of the Informatics Commission. Dreyer also discussed the Imaging 3.0 Informatics Portfolio, a set of tools to support radiologists providing patient-centered care in new payment structures. The portfolio's components include the following:
• ACR Select®, the digitally consumable version of the ACR Appropriateness Criteria® for clinical decision support
• ACR Common™, a collection of common radiology terms and semantic structures that facilitates interaction with ACR products and services
• ACR Connect®, a communication framework designed to facilitate bi-directional information flow between vendors and ACR products and services
• ACR Assist™, a clinical decision support framework designed to provide structured clinical guidance to radiologists.
The CMS Medicare Imaging Demonstration Project results reinforce the need for ACR Select as a decision support tool for ordering physicians. Between 2011 and 2013, just 20 percent of radiologists were participating in meaningful use. Without further modifications to the regulations, penalties for non-participation are expected to affect radiologists no later than 2019. Meanwhile, ACR government relations staff will continue to work toward resolving outstanding challenges regarding CMS and the Office of the National Coordinator for Health Information Technology.
As part of the strategic plan, the board also established guidelines for the approval of unbudgeted initiatives. Additionally, the board put forth a number of new policies to increase involvement and transparency in ACR activities.
The Board Meeting featured several other items of interest, including guidance on safe and effective patient care in biocontainment situations, a recent survey on the ABR change in initial board exam dates and the impact the adjustment may have on hiring practices, and an in-depth discussion on the future of research activities. The BOC will next meet at ACR 2015 in May.
BOC Meeting Highlights
The BOC focused on the following at this year's winter meeting:
• The program assessment phase of the newly adopted ACR Strategic Plan
• Extensive ACR efforts to cover high-risk lung cancer patients with low-dose CT lung cancer screening
• Congressional and regulatory activities since the September BOC meeting
• Ongoing activities related to Imaging 3.0™
• New board policies and resolutions in preparation for ACR 2015
By Bibb Allen Jr., MD, FACR, Chair