A team of experts offered their views on the evolving health care landscape and the impact its changes will have on radiology during a three-hour hospital administrators symposium held during the 102nd annual meeting of the Radiological Society of North America.
The main topic of the afternoon was, of course, the Medicare Access & CHIP Reauthorization Act of 2015 and what radiologists need to do to be successful under the new value-based payment system. This discussion also included descriptions of the plethora of new health care acronyms MACRA has unleashed.
Ezequiel Silva, M.D., chair of the American College of Radiology’s commission on economics, described how 2017 and 2018 will be transition years for MACRA and noted that “we do have time.”
Richard Weil, a Highland Park, Ill.-based consultant, struck a similar tone and explained that it is in the Centers for Medicare & Medicaid Services’ interest for MACRA to have a successful implementation. For example, he noted how CMS had set ambitious goals for physicians to participate in alternative payment models and one way this is being advanced is by expanding the definition of an APM.
“I’m not saying that’s what’s done, but that’s what’s done,” Weil said. “There’s a lot of candy CMS is putting out there to get people to participate in programs.”
Silva was heartened at how MACRA scoring will be on a graduated scale rather than the “thumbs-up or thumbs-down” judgment physicians received under Medicare’s Physician Quality Reporting System program — although he also warned: “I don’t want to act like this is easy.”
In fact, he pointed out a difficult policy choice ahead for radiologists. MACRA offers different paths for patient-facing and nonpatient-facing physicians. Radiology quality measures may suggest that joining physicians like pathologists on the second path might be more appropriate, but Silva argued against that.
“I think we’re stronger if we’re collectively judged with the other physicians,” Silva said. “We want to be in this bigger pool. That’s how we stay relevant.”
Maintaining relevancy and removing radiologists from their isolated posts and integrating them back into the provider workflow have been major elements of the meeting’s “Beyond Imaging” theme.
Pat Free, national vice president for radiology operations for McKesson, detailed how radiology’s reimbursement has taken a hit since changes were implemented by the Deficit Reduction Act of 2005.
Free identified seven types of radiology practice structures, each with its own set of pros and cons. He predicted rapid change likely would continue in response to regulatory and economic factors that cause radiology groups to “seek shelter.”
Diego Martin, M.D., Ph.D., was introduced as a “world-renowned expert” on magnetic resonance imaging, but even he admitted confusion over what lies ahead with MACRA implementation.
“My head’s about to explode,” said Martin, the medical imaging department head at the University of Arizona College of Medicine in Tucson.
Among all the take-home messages delivered, Martin’s was the most direct.
“Accuracy and precision is where we’ll get our biggest bang for the buck,” Martin said, as he explained how radiologists could help to drive down costs even while using expensive technology.
Standardization of procedures can lead to a one-and-done strategy that eliminates the need for multiple radiological studies while providing better diagnoses, treatment and outcomes, Martin said, particularly for stroke and cancer patients.
“It’s a big cost impact when you get it wrong, but a big value when you get it right,” Martin said, noting how techniques such as virtual biopsies could lead to reducing the cost of care and the number of tests and errors, along with providing improved diagnoses and correct therapies.