April 18, 2024

Challenges and Opportunities to Fund the Future Take Center Stage at ACR 2024 Economics Forum

The always popular Economics Forum at ACR 2024, the American College of Radiology® (ACR®) annual meeting engaged attendees, exploring new payment models for radiation oncology, the challenges of duplicating such models in diagnostic radiology, updates on the Medicare Physician Fee Schedule, and funding issues related to the radiology workforce crisis.

Gregory N. Nicola, MD, FACR, Member of the ACR Board of Chancellors (BOC), Chair of the ACR Commission on Economics, and part of the executive leadership team at Hackensack Radiology Group, was moderator for the forum. Speakers were Dave Adler, MA, American Society of Radiation Oncology (ASTRO) vice president of advocacy; Lauren P. Nicola, MD, FACR, Member of the ACR BOC, Chair of the ACR Reimbursement Committee, and CEO of Triad Radiology Associates; James Milburn, MD, MMM, FACR, vice chair of the department of radiology and director of neurointerventional services at Ochsner Health System, and professor radiology at the University of Queensland; David B. Larson, MD, MBA, FACR, Member of the ACR BOC, Chair of the ACR Commission on Quality and Safety, and professor and executive vice chair, department of radiology at Stanford University School of Medicine; and Ben Wandtke, MD, MS, vice chair for quality and safety at the University of Rochester Medical Center.

Dr. Gregory Nicola set up the forum’s two-part format, first covering payment reform and workforce issues, then highlighting a unique program the College is overseeing that provides tangible and positive safety and business operational improvements.

Adler talked about a new program proposal ASTRO put forward that he believes is progressive and innovative and will bear fruit. He said ASTRO is trying to address clinical and reimbursement trends in radiation therapy. “These have driven the development of a new payment proposal that we call ROCR, or the Radiation Oncology Case Rate Program,” he said. “The goal with ROCR is to realign payment incentives around high-quality care.” Adler said momentum is building around this policy proposal as ASTRO works with stakeholders like ACR and folks on Capitol Hill.

Dr. Lauren Nicola talked about alternative payment models in diagnostic radiology and differences between it and radiation oncology. “First and probably the most important one is that diagnostic radiologist care isn’t episode based,” she said. “What that means is that we don’t really have a defined start and end to the care that we provide for a patient. It is difficult to build a payment model around care that is not evidence-based.”
She also talked about challenges around the Merit-based Incentive Payment System (MIPS) and Medicare fee for service. On the latter, Nicola said, “We know that Medicare reimbursements have declined over the last couple of decades, especially compared to inflation. We don’t see a lot of light at the end of that tunnel, but the ACR and its coalition of specialties is fighting hard.”

Dr. Milburn spoke about current workforce challenges, mainly related to the aging population and residency slots. “Luckily, radiology is very popular among medical students, but it is also very competitive,” he said. “We have more applicants than we have radiology positions, and there are a ton of great applicants that don’t match into radiology who could be excellent radiologists.” “A good take home point from this talk is that if anyone here is in a teaching program or associated with advocating at their local levels to add more residency positions, maybe look to private funding,” Milburn said. “Because many future hires originate from our own residency programs, we can argue that privately funding positions through health systems could increase the number of residencies — a nice source of future hires.”

Dr. Larson discussed ACR’s Learning Network and his experience participating in the program. “The Learning Network is a team-based experiential program that does two things simultaneously. One is to train radiologists and staff teams in moderate improvement methods, and two is to facilitate successful improvement,” Larson said. “We train people while at the same time they are making a difference in our organization. We help you at your local site, or local sites put together teams with physician leaders and team leads and/or administrator or staff leaders. Participants also get the support of a quality improvement coach,” he said.

Dr. Wandtke also spoke about how the Learning Network uses quality improvement to help participating sites better their bottom line. He talked about his group’s participation for the purpose of improving its lung cancer screening program. “We thought our program was doing pretty well,” Wandtke said. “But when we stopped and thought about this a little bit more, we realized that it is inadequate compared to other mature screening programs like those for breast and colon cancer screening.”

“When we heard that the Learning Network was doing a project to help institutions improve their lung screen participation, we jumped right in,” Wandtke said. “What was different about the program is that they helped us build a project team that was more diverse than any quality improvement project I have ever worked on. You have a tremendous opportunity to add value to your health system and for your patients by working on your lung cancer screening and other programs through network participation.”

Chad Hudnall, senior writer, ACR Bulletin