RFS Journal Club: Alternative Payment Models in Radiology
This month’s resident and fellows journal club featured an article written by Ezequiel Silva III, MD, Geraldine B. McGinty, MD, MBA, Danny R. Hughes, PhD, and Richard Duszak Jr, MD entitled, “Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform,” which was featured in the October 2016 edition of the JACR®.
Dr. Silva joined the RFS for an engaging discussion spanning from the introduction of the sustainable growth rate (SGR) as part of the Balance Budget Act of 1997 to the multiple patches in the intervening years and finally to MACRA, which replaced the SGR with a value-based incentive system for physician payment.
Dr. Silva discussed the Merit-Based Incentive Payment System (MIPS), by which physicians and physician groups will be scored, and how this will affect radiologists. He emphasized the importance of the “quality” category, which will account for 85 of the 100 points assigned to non-patient facing physicians, such as diagnostic radiologists (50 points for patient-facing physicians). Although there is some uncertainty given the new leadership in Washington, including new Secretary of Health and Human Services, Tom Price, Dr. Silva reminded the group that MACRA is already here — the 2019 fee adjustment is based on 2017 data.
Radiologists will also have the opportunity to take part in advanced alternative payment models (APM), which reward physicians for taking a stake in patient outcomes. The economic incentives to participate in APMs include exclusion from MIPS, a 5 percent bonus payment from 2019‒2024, and a 0.75 percent increase in the conversion factor starting in 2026 (0.25 percent increase for MIPS participants). More than ever, physicians from various fields will need to collaborate to provide value and improve patient outcomes. Radiologists will have an opportunity for a leadership role here.
The ACR MACRA committee has already provided meaningful feedback to CMS and has successfully helped to change key provisions in the MACRA final rule. CMS has lowered some of the thresholds for reporting in the initial year, has increased thresholds for the patient-facing designation and provided clarity on group reporting for those with both patient-facing (e.g. interventional radiologists) and non-patient facing providers.
The residents and fellows had insightful questions for Dr. Silva followed by a nuanced discussion that could have gone well beyond the allotted time. As the future of radiology, it is essential that members of the RFS be informed in economic policy so that they too can drive policy changes on behalf of radiologists and patients. Dr. Silva has proven to be an invaluable resource for the group.
By Seth Stein, MD, ACR RFS Economics Advisory Group (ACR-RFS EAG)
Radiology Resident, NewYork-Presbyterian Weill Cornell Medical Center, New York, NY