2005 ACR Economics Forum


ACR Readies Itself for Looming Economic Challenges

In today's unrelenting health care environment, radiologists spend nearly as much time with numbers as they do with images, especially when it comes to Medicare coverage and reimbursement issues. While each day presents new economic challenges to radiology, there have been significant accomplishments in this area during the past year and these were highlighted during the Economics Forum held as part of the recent ACR Annual Meeting and Chapter Leadership Conference.

Among the key economic successes of the past year:

  • Universal coverage and Medicare reimbursement for low-osmolar contrast media
  • Additionally covered diagnosis codes for services such as CT colonography and CT of the thorax at the state level
  • Appropriate Medicare payment for brachytherapy sources
  • Aetna reimbursement for computer-aided detection in mammography
  • Aetna reimbursement for continuing medical physics consultation

This year's forum featured an array of noted radiologists who spoke of the achievements of the College's Commission on Economics and its associated committees. Meanwhile, each forum speaker outlined radiology's future challenges and noted how the College is positioned to best address them. The forum also featured representatives from several Washington, DC-based health policy consulting firms who offered a global perspective on Medicare's future.

The Economic Goals for 2005-2006

John A. Patti, MD, chair of the Commission on Economics, delivered an economics overview and regulatory update, providing details on the 2005 Medicare Physician Fee Schedule. He also outlined the commission's key focus areas for the coming year, including:

  • Role delineation of the radiologists assistant and working with CMS to establish correct supervision levels
  • The sustainability of the Medicare program, specifically the sustainable growth rate (SGR)
  • The focus of congressional advisory committees, including the Medicare Payment Advisory Commission, on diagnostic medical imaging

Patti explained that the SGR is a critical matter for ACR members as it is a primary factor for determining physician payment rates, albeit it is a flawed process. The formula's flaws have been resulting in negative physician payment updates, but Patti explained that policy makers and lawmakers alike are looking to change the physician reimbursement system. More importantly, he assured attendees that the ACR will continue to monitor these problems and potential solutions.

"I want to work toward a system that recognizes efficient, quality care," Patti said, quoting Sen Charles Grassley (R, Iowa), chair of the Senate Finance Committee. "The move toward a value-based purchasing system will increase the quality of care and avoid unnecessary costs to the Medicare program. We need to find a physician payment system that works."

Member Participation Necessary for 5-Year Review

The upcoming 5-year review and the critical need for ACR member participation in the survey was the next topic of discussion.

"This will have a direct impact on professional component reimbursement for certain services and participation in the process is one way radiologists can help ensure appropriate reimbursement for radiology," noted Bibb Allen, Jr, MD, vice chair of the Commission on Economics.

The 5-year review is a congressionally mandated process that requires a critical look at physician reimbursement for billing codes that are considered potentially misvalued. Allen told the attendees that the Centers for Medicare and Medicaid Services had submitted 22 diagnostic and interventional radiology codes and 8 radiation oncology codes for the upcoming review. Meanwhile, he added, the ACR jointly submitted cardiac MRI codes with other organizations in anticipation of updating the CPT® codes for this particular study.

Allen encouraged members to complete surveys on their time spent on these specific studies this summer and suggested that the composite data will be presented to the Relative Value Update Committee in August, with implementation planned for 2007. Allen also briefed attendees on changes in practice expense reimbursement, expectations of the 2006 Medicare Physician Fee Schedule, and current initiatives at the local Medicare level.

The Coding Challenge

While the ACR has several committees relating to varying economic issues, perhaps the most active committee is the one addressing coding and nomenclature issues. Committee Chair Richard Duszak, Jr, MD, briefed attendees on recent and emerging changes to the CPT® codes, useful ACR coding resources, and the importance of employing certified radiology coders.

With the College turning an increasing amount of attention toward private payer activities, Christopher G. Ullrich, MD, chair of the ACR's Managed Care Committee and Network, outlined many recent activities. Among the key items mentioned were the upcoming member resource on contracts and billing systems, ACR collaborations with the health insurance industry, and cooperation with the College's quality and safety department to evaluate new payer initiatives such as a "provider report care."

Meanwhile, a newly formed committee to address initiatives surrounding hospital outpatient reimbursement was announced by its chair, James V. Rawson, MD, who outlined the committee's goals.

The Views from Outside the College

Several well-known health care consultants offered the forum audience their unique perspectives on today's ever-changing health care marketplace and the future challenges for Medicare.

"All of the painless ways to finance Medicare are used up," Donald W. Moran, president of The Moran Company, told the audience. "From here on out, Medicare will be competing against Social Security for tax and premium resources."

Moran held everyone's attention with his broad overview of the domestic fiscal policy concerns that will drive key aspects of the Medicare program in the future, including the effect of the accelerating cost of health care on individual taxpayers and Medicare beneficiaries. He also provided specifics on the SGR formula, which is used to determine Medicare payment updates, and offered his opinion on physicians' growing reliance on imaging to increase office-based revenue. Ultimately, he noted, quality and safety standards may act as a deterrent for financially motivated use of imaging.

"If the standards regarding equipment, staff qualifications, and interpreter training are tough, the deterrent effect would be substantial," Moran emphasized.

Specific changes to the Medicare program were the focus of the presentation by Harry R. Desmarais, MD, of Health Policy Alternatives, Inc, including an explanation of how the program plans to change its coverage determination process to align itself with evidence-based decision making and the new emphasis on the use of health information technology.

However, the issue at the heart of Desmarais' talk was the growing trend toward a pay-for-performance approach to reimbursement.

"This is an inevitable reality," Desmarais told the attendees. "Given bipartisan interest in the idea, the ACR needs to explore how it might work for the radiology community and get ready to make concrete recommendations for implementing such a program for imaging," areas where the ACR already is focusing its efforts.