In Case You Missed It
ACR 2015: Monday May 18
Here's what happened on day 2 of the conference.
Donald P. Rosen, MD, director of clinical research, started his clinical research update with an equation:
Research + Imaging Innovation = Clinical Practice
He traced for attendees the role research plays in bringing new innovations to patients. Innovation without research produces technologies without proven application to patient care and without adequate information on safety and effectiveness. “Clinical research is essential for evidence-based practice,” said Rosen. “If we don’t do the research, we can’t expect to own the innovation.”
Rosen also discussed the recent restructuring of the ACR Clinical Research and Innovation Center in Philadelphia, which he described as a “proactive response to a changing environment.” Factors included the changing national research model, reductions in NIH funding, and consolidation of research activities.
Rosen also detailed recent efforts by the Harvey L. Neiman Health Policy Institute (HPI). The institute has focused on peer-reviewed scientific research papers, white papers and policy briefs, bundled payments, and decision support analytics. The HPI also provides data and direct analytical support to ACR’s Economics and GR departments. In the past year, the HPI has produced 13 scientific papers (in print or accepted for publication), given more than 30 presentations at scientific meetings, and launched the Neiman Almanac data tool.
Milton J. Guiberteau, MD, FACR, president of the American Board of Radiology (ABR), briefed attendees on news from the world of maintenance of certification. “Radiologists are caught up in the unprecedented and profound restructuring of the U.S. health care system,” said Guiberteau. This restructuring affects how radiologists are certified, how radiologists run their practices and care for their patients, and how radiology services are valued. “How we respond to these challenges will affect our profession now and for generations to come,” said Guiberteau.
The ABR has responded by refocusing its strategy. “Radiologists must be accountable for mastering the competencies and meeting the quality and safety mandates of our time with meaningful changes in our programs,” said Guiberteau. To that end, the ABR focuses on maintenance of certification through a continuous process that covers a broadened spectrum of competencies. “It is necessary to be good physicians,” said Rosen. “It is also necessary to be paid for being good physicians.”
Maintenance of certification is divided into four parts:
- Part I: Professional standing (One valid, unrestricted state medical license)
- Part II: Lifelong learning and self-assessment (Diplomate-directed CME with emphasis on practice setting)
- Part III: Cognitive expertise (Diplomate-specified practice-profiled examination)
- Part IV: Practice quality improvement (Diplomate-guided efforts to enhance their practices and the care provided to patients)
“ABR MOC Requirements must assure the public of a robust MOC program to support radiology’s most widely accepted and empowering credential for delivering and advancing quality healthcare,” concluded Guiberteau. “But requirements must also be balanced with diplomates’ satisfaction and sense of accomplishment in performing an MOC program that is reasonable and respectful of the busy and complex environments in which they practice.”
Jennifer E. Nathan, MD, ACR Young Physician Section (YPS) vice chair, began with a definition of this distinctive section within the College. Any ACR member younger than 40 years of age or within 8 years of completion of training is eligible for the YPS, said Nathan. The section includes a total of 6,069 members. “These members are focused on establishing and growing a career, starting or balancing a family, paying debt, networking, and maintaining certification,” said Nathan.
To serve its members, the YPS aims to facilitate involvement in the College and foster future leaders. This year, the section made serious significant progress. Leaders established a YPS column in the JACR®, which was kicked off with a two a two-part series on leadership for young radiologists. The section also sent out a quarterly newsletter to keep members up to date and continued the YPS Mentor Network. Nathan also highlighted the SoFi loan refinancing program, which saves the average physician $20,800 at refinancing.
Nathan also reported on the first RADTOBERFEST, a fundraising event based on the March Madness challenge. State chapters compete against each other in four divisions based on chapter size. A total of 186 YPS members contributed during the campaign, many of them first-time donors.
The YPS report closed with goals for the future. The section plans to facilitate YPS involvement in the ACR by carving out an easier route to get involved with committees. Young physicians also aim to strengthen their networks through involvement in state chapters, joint activities with College leadership, and advocacy efforts.
This year, the RFS set about integrating the College’s youngest members into the fabric of the organization. “We want to facilitate and empower residents, fellows, and young physicians to engage in ACR,” said Andrew K. Moriarity, MD, RFS chair. RFS members participated in various commissions, including the Commission on Economics, and met as a journal club to discuss current issues in radiology.
Moriarity also provided a snapshot of the RFS by the numbers:
- • 380 members registered for ACR 2015.
- • 115 RFS posters were displayed at ACR 2015.
- • 662 residents and fellows enrolled in the Radiology Leadership Institute .
- • RADPAC donors have doubled over the past two years.
- • The RFS Twitter audience is four times what higher than it was one year ago.
In reporting on the activities of the RFS, Moriarity explored the difference between paying dues to a society and being engaged in an organization. “Don’t show me a membership card; introduce me to a community,” he said. “Don’t tell me about service; demonstrate the value of volunteering.”
Patrick Conway, MD, CMS chief medical officer and deputy administrator for innovation and quality, kicked off part one of Monday’s ACR 2015 Economics Forum by proclaiming his organization’s driving principle: better care, smarter spending, and healthier people. “Improving the way providers are incentivized, the way care is delivered, and the way information is distributed,” explained Conway, “will help provide better care at lower cost across the health care system.” Conway went on to delineate some of the different forms that such improvements, mostly new reimbursement models, would take: accountable care organizations, medical homes, bundled payments, and programs to reduce readmissions and hospital acquired conditions. But what will radiology’s place be in this new world of value-based payment structures?
HHS’s recent announcement about its future goals for alternative payment systems offered a hint. As Conway noted, HHS has laid out two main goals for the transition to value-based payments: first, 30 percent of Medicare payments will be tied to quality or value through alternative payment models by the end of 2016, and 50 percent by the end of 2018. The organization’s second goal will be that 85 percent of all Medicare fee-for-service payments will be tied to quality or value by the end of 2016, and 90 percent by the end of 2018. These timetables don’t give radiologists long to decide how they will begin demonstrating value relative to both patients and to the other physicians.
Ezequiel Silva III, MD, FACR, member of the ACR Council Steering Committee and chair of the College’s Reimbursement Committee. underscored the urgency and opportunity presented by CMS’ ambitious goals. Silva, who is ACR’s advisor to the Relative Value Scale Update Committee (RUC) — the body responsible for valuing physician work for new and revised CPT® codes — emphasized the need for the RUC to evolve to keep pace with emerging alternative payment models. At the RUC meeting in January, Silva noted, the committee’s work advising CMS rested on the same methodology used for the past 20 years: assigning individual values for CPT codes. Silva stressed the importance of the RUC evolving to determine how procedures might be valued within future alternative payment models — such as bundled episodes of care — and highlighted the need for radiology to align itself with HHS’s recent mandates.
During the past few years, Imaging 3.0TM — the movement from volume- to value-based imaging — has dominated the conversation at the annual meeting’s economic session. This year, however, was marked by important developments in the form of real-world examples and applications of Imaging 3.0 principles. Such actions were undertaken by ACR members throughout the country and by College committees under the auspices of the Economics Commission.
“We are putting Imaging 3.0 into a more actionable context,” explained, Mark O. Bernardy, MD, FACR, chair of the ACR’s Managed Care Committee. He highlighted the Most Valuable (Radiology) Practice framework, which was featured as an infographic in the May issue of the ACR Bulletin. He noted that the infographic is to be a guide for radiologists on how to implement Imaging 3.0. He also explained some of the proactive efforts that the committee has undertaken to help educate CMS, payers, and the RBMA about the importance of imaging and the role of radiologists as a central part of the health care team.
Joaquim Farinhas, MD, provided session participants with several examples of Imaging 3.0 Case Studies. These case studies cover examples of radiologists who have overcome significant challenges within their local health care systems and improved relationships with their hospitals. In all of the cases, he noted, the radiologists made a singular effort to engage with others and be at the table at which decisions are being made. He urged all of the participants to become more involved in governance and to network with fellow physicians and other hospital stakeholders.
Geraldine B. McGinty, MD, FACR, chair of the Commission on Economics, continued the discussion of Imaging 3.0 by demonstrating the potential applications of ACR Select to become seamlessly integrated into the ordering systems, reference materials, web portals, and other inputs and outputs used by members of the health care team. She also noted that as of January 1, 2017, CMS will require clinical decision support (CDS) consultation to qualify for Medicare reimbursement. McGinty noted that in the eyes of CMS, CDS has gone from a “that’s interesting” category to a “must do” category. Implementation of CDS provides radiologists with an opportunity to demonstrate their value, she said.
The session concluded with Raymond K. Tu, MD, chair of the ACR Medicaid Network, who provided examples of how he and other members of the network applied Imaging 3.0 principles by carefully fostering important relationships with the heads of all of Medicaid’s 10 managed care organizations. One of those organizations was AmeriHealth Caritas, which now has a medical policy review process that “is collaborative [with ACR] and has a significant impact on appropriate coverage under the Medicaid system.”