A Memorable Meeting
The ACR Board of Chancellors (BOC) and Council Steering Committee (CSC) conducted their spring meeting May 16 and 19, 2015, in Washington, D.C.
Occurring in conjunction with ACR 2015™, the leadership discussed opportunities to bolster member engagement, to continue ACR’s commitment to fiscal responsibility, and to aid radiologists and practices in adapting to health care reform.
The group also reviewed recent successes in advocacy and economics. ACR leadership enthusiastically reported that implementation of the fall 2014 strategic plan and program assessments is well under way, providing a growing culture of accountability and strategic alignment. Anne C. Roberts, MD, FACR, outgoing ACR secretary-treasurer, reported that target benchmarks for the 2016 budget year were achieved. ACR CEO William T. Thorwarth Jr., MD, FACR, informed the BOC of important ventures during the past quarter, including the launch of the JACR Informatics Resource Center, advances in accreditation through streamlined processes via web-based technologies, a comprehensive redesign of the JACR® and the ACR Bulletin, and development and execution of ACR 2015. He also reported on the launch of version 1.0 of the ACR Common™ (offering ACR radiological terminology of common procedures, indicators, findings, and recommendations).
Paul H. Ellenbogen, MD, FACR, presented his final President’s Report to the board after 22 years of service to the College. He cited the opening of the Radiology Leadership Institute® and the Harvey L. Neiman Health Policy Institute™, the decision to preserve radiologic-pathologic offerings through the AIRP® following the closure of AFIP, as well as the first all-member ACR 2015 meeting as just a few of the significant highlights during his tenure on the board.
David C. Kushner, MD, FACR, chair of the Commission on Membership and Communications reported that the commission continues to convey the value of ACR to both members and non-members through strengthened membership outreach programs and more targeted volunteer engagement opportunities. He also announced consideration of an ACR section dedicated to retirees and seniors. Kushner also conveyed that two-thirds of membership dues directly fuel the ACR’s powerful government relations and advocacy efforts.
Policy & Patient-Centered Care
Geraldine B. McGinty, MD, MBA, FACR, Barbara S. Monsees, MD, FACR, and Debra L. Monticciolo, MD, FACR, reported on the breast cancer screening advocacy initiative, which seeks to ensure that future leaders are equipped with the skill and knowledge to advance breast cancer screening to the benefit of women everywhere. Feedback from participants indicated the success of the comprehensive curriculum, including screening basics, trials, evidence, literature evaluation, models, harms and benefits, economics, breast imaging outcomes, and communications.
McGinty reported that the Imaging 3.0™ Practice Visitation Program has reached approximately 300 radiologists across the U.S., with participating radiologists welcoming visiting ACR representatives to consult on opportunities to align operations with Imaging 3.0 principles. Representatives facilitate discussions on practice issues including governance, adapting to health system goals, business management, and succession planning. Participating practice leaders have communicated that the program has provided invaluable lessons on health informatics, leadership, and practice models.
Marta Hernanz-Schulman, MD, FACR, provided the Commission on Pediatric Radiology update, reporting that recent efforts resulting in studies and protocols have allowed the process of accreditation for pediatric hospitals to be streamlined. Lincoln L. Berland, MD, FACR, explained in his report that the Commission on Body Imaging will continue efforts to expand both private and public payer reimbursement for colorectal cancer screening.
Advocacy & Economics
Cynthia Moran, ACR executive vice president of government relations, economics, and health policy, provided a legislative update. Moran highlighted details of the sustainable growth rate (SGR) repeal, alternative payment models (APMs), and efforts to repeal the Affordable Care Act. She informed the BOC that while the Affordable Care Act may be repealed with a simple majority, the president is expected to veto any such repeal. Moran noted that Medicare fees are projected to increase due to the SGR repeal and that the Child Health Insurance Program has been extended for two years.
Regarding APMs, Moran reported that the next two years will be critical in terms of developing a functional payment system targeting the evolving emphasis on quality measures. Moran added that there remain serious questions concerning benchmarking in the program and commented on the likelihood benchmarking could devolve into payment randomization, or cuts/bonuses depending on which metrics are used and where one's practice fits in any given year. She thanked the ACR government relations team for their work and reiterated the significant success of passing ACR’s top legislative priorities when less than 3 percent of all bills were enacted in 2014. Looking to the future, Moran identified some government relations priorities, such as reforming the multiple procedure payment reduction, responding to a USPSTF draft recommendation on mammography screening, and providing ACR input for health IT oversight limitations.
McGinty provided the ACRA® Economics Update, highlighting the future of the Physician Quality Reporting System, clinical decision support, and concerns about USPSTF recommendations. She noted that while many radiology services will remain in fee-for-service models, Medicare payments are expected to stabilize over the next 10 years as they become increasingly tied to patient value. She reported further that the Physician Quality Reporting System and value-based modifiers would be retired by 2019 in favor of Merit-Based Incentive Payment Systems focusing on quality, cost, and patient satisfaction. Regarding APMs, McGinty noted that CMS is expected to present an outline for the future in the 2016 proposed rule and that the ACR Commission on Economics has already begun collaboration with leaders across the College and within constituency groups to inform a proposal regarding the details of the payment models.
She advised that clarity on clinical decision support and appropriateness criteria are expected in the upcoming proposed rule but details on the methodology are not due until 2016. McGinty noted that the Commission on Economics provided feedback to CMS concerning the complexity of lung screening, recommending a 30 percent increase from the chest screening valuation. Despite an overall optimistic report, McGinty expressed concerns about USPSTF recommendations, with some payers already beginning to require documentation of biannual mammogram recommendations.
SGR reform and the Merit-Based Incentive Payment Systems provide ample opportunity for the profession to demonstrate and define value. The future strategy of the College will include offering radiologist-developed metrics and a practical reporting solution through qualified clinical data registries to facilitate value-based reimbursement. James A. Brink, MD, FACR, vice chair of the BOC,then reported on the MGH Interventional Radiology Symposium, an outstanding effort to introduce interventional radiology to medical students. Brink reported that this symposium, the first of its kind, markedly increased the understanding of the radiologist’s role in patient care, with attendees expressing an increased interest in radiology as a future profession.
The ACR is working with a number of radiology organizations to unite efforts to increase the appeal of the profession to future generations, strengthen multispecialty collaboration, and formulate a joint commitment to innovation for the future of radiology. These and other activities are sure to be addressed at the fall BOC meeting in September.
By Bibb Allen Jr.,MD,FACR, Chair