Transforming Practices

More than 140,000 clinicians will be transforming their practices over the next four years. The ACR Commission on Economics wants radiology engaged.transforming practice

"Better care, smarting spending, and healthier people." CMS has committed $685 million to support these important goals through the Transforming Clinical Practice Initiative (TCPi). It is imperative that we are engaged in this effort. In this column, I describe ways in which radiology can participate.

TCPi seeks to achieve large-scale health transformation by producing a new model of health care built upon collaboration, teamwork, and value-based payment. As part of this effort, TCPi has awarded funds to 29 Practice Transformation Networks (PTNs) and 10 Support and Alignment Networks (SANs). The PTNs are peer-based learning networks supporting collaboration among a broad community of practices and include such institutions as the Mayo Clinic and larger health care systems, such as the Washington State Department of Health. The SANs are professional medical societies and organizations that provide resources to aid physician practices in their transformation efforts. Using existing and emerging materials and tools (e.g., continuing medical education, maintenance of certification, and core competency development), the SANs actively support new learning opportunities.

The ACR is one of only 10 SANs, through its Radiology, Support, Communication and Alignment Network (R-SCAN). While many organizations applied for grants, the ACR was one of the few to receive TCPi funding. R-SCAN provides a step-by-step plan for engaging referring physicians in clinical decision support (CDS) and improved imaging appropriateness through a growing number of Choosing Wisely topics, such as unnecessary preoperative chest-xrays. As part of R-SCAN, participants receive access to ACR Select® (the CDS product based around the ACR Appropriateness Criteria®). To help this improvement, the R-SCAN website ( provides extensive educational resources, including white papers, slide presentations, and podcasts on imaging evidence. Participants collect ordering data pre- and post-educational intervention and CDS use to evaluate and document the improvements gained.

So what's in it for us? R-SCAN gives practices a head start in implementing CDS within their practices. The Protecting Access to Medicare Act (PAMA) of 2014 mandates the use of CDS starting as early as 2018. And the stakes are high. For practices that fail to implement CDS, payment for advanced diagnostic imaging will be denied.

The individual benefits to radiologists and their practices include free CME, MOC Part IV credit, and access to a web-based version of ACR Select customized for R-SCAN. Participation in TCPi also earns points within the Clinical Practice Improvement Activities performance category of the forthcoming Merit-Based Incentive Payment System

We have a number of options for implementing R-SCAN, from statewide partnerships to purely local efforts. Partnership opportunities exist within PTNs, which makes sense because many radiologists practice within the geographic domain of a PTN. For example, the Colorado PTN and R-SCAN have forged a partnership to ensure appropriate imaging and to lower the cost of care in Colorado. Partnership opportunities are also available between SANs. For instance, the American College of Emergency Physicians and the ACR are working together with the goal of avoiding more than 1.1 million unnecessary imaging tests by putting tools in place to select the most appropriate examinations. We can certainly apply R-SCAN in our local practices by providing the leadership in engaging our referring physicians and health care systems in the broader shift from volume- to value-driven care.

The requirements for the ACR to maintain its annual TCPi funding are fairly aggressive. We have committed to engaging 4,000 radiologists and 20,000 referring physicians in R-SCAN over four years. We simply cannot fail in our recruitment efforts, as many stakeholders are watching. We cannot give the impression that radiologists do not support the goals of CDS. Equally important, we must provide the data that CDS works and that collaboration yields favorable outcomes for patients. If not, we may not like the alternative to CDS: radiology benefits managers that require preauthorization without the clinical expertise radiologists provide.

Thousands of clinicians are working to transform their practices, and radiology is well positioned to contribute to this effort. We have this opportunity to be leaders locally and nationally. Our tool is R-SCAN. Join the many practices already participating — the time to sign up is now.

dr silvaBy Ezequiel Silva III, MD, FACR, Chair

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