Back to School
While many individuals have filled the past few months with summer fun, the ACR has been busy innovating.
Who can forget that "back to school" feeling? Starting a new school year was always energizing for me, even if there was some regret that the lazy days of summer were over.
At the ACR, this has hardly been a lazy summer. Between preparing our comments on the Medicare proposed rules and strategizing around the U.S. Preventative Services Task Force recommendations on lung cancer screening, the pace barely slowed. While many of our activities are repeat performances, our economics team has been at the forefront of a number of innovative efforts that I want to share with you.
With so much talk about payment reform in health care, a critical goal for your ACR Commission on Economics has been to understand how radiologists can survive and thrive in new payment models. We have an active Radiology Integrated Care Network that gathers information from members already participating in accountable care organizations and other integrated care-delivery systems. The leadership of this network has already published on radiologists' experiences in these models and will continue to educate members as the models mature.
In addition to gathering information from the field, we are actively engaged in developing potential bundled-payment models that will recognize and reward the value of imaging care provided by radiologists. I have participated in several efforts in the past to develop bundled or episode payments, and the hurdles are significant. Deciding on the distribution of payments and attributing both savings and costs can be complex. Often radiologists are not regarded as being central to the care-delivery process, a perception we are working hard to change through our Imaging 3.0™ initiative.
Recently we have been working collaboratively within the ACR, with the Neiman Health Policy Institute, and with other groups such as the Brookings Institute and the AMA to develop models that will both promote effective care and appropriately recognize the efforts of all members of the care-delivery team. Areas of initial investigation relevant to radiologists are breast cancer diagnosis, management of incidentally detected pulmonary nodules, and the initial evaluation of stroke. You'll certainly also be hearing more about lung cancer screening in the near future; it represents an opportunity for radiologists to take the lead on an important public health initiative, just as we did for breast cancer screening. We aim to put radiologists right in the center of developing the program. Watch this space over the coming months for more details.
Our efforts are timely not just because of the CMMI bundled payment initiative. The Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System represent the payment world in which we all currently exist — and even these are changing. With language in the Proposed Rules for 2014 that seeks to equalize payments across various settings and discusses the development of bundled payments around surgical and other procedures, it is wise for us to take the initiative on making sure radiologists' contributions are adequately reimbursed.
Another exciting effort has been our pursuit of a CMMI Innovation Award to study and promote the use of appropriate imaging through education of and consultation with referring providers and greater engagement with patients. Decision support using the ACR's Appropriateness Criteria® represents the cornerstone of our efforts to highlight the value that radiologists deliver. We have been working closely with partners, such as the Altarum Institute, to demonstrate the benefits of the appropriateness criteria. Altarum received an $8.4 million grant in 2012 to work on reducing unnecessary imaging within a primary care network in Michigan using the ACR Appropriateness Criteria. When CMMI announced a second round of funding this summer, we at the ACR saw an opportunity to build on this important work. Pulling together partners from across the country and crafting the application and the payment model required to qualify for funding was an example of the ACR's economics team doing what it does best: representing members' commitment to the highest-quality patient care and advocating for payment models that support that commitment. Awards will be announced early next year.
All the efforts outlined above take place within an overall strategy that continues to prioritize fair fee-for-service reimbursement for radiologists. Fee-for-service remains the world in which most of us live and work, and this will be the starting point as we determine our place in bundled payment models. It is therefore incumbent on us to advocate as strongly as possible against further illogical payment reductions, which we continue to do by engaging payers and policy-makers. But we would be foolish not to heed the drumbeat of payment reform.
By Geraldine B. McGinty, MD, MBA, FACR, Chair