December 02, 2016

ACR Delivers MACRA Lessons to RSNA Meeting

Top echelon American College of Radiology (ACR) leaders presented radiologists and their administrators with four major opportunities at RSNA 2016 to appreciate the immediate and longer-term implications of the Medicare Access and CHIP Reauthorization Act (MACRA) for themselves and their practices.

James A. Brink, MD, FACR, chair of the ACR Board of Chancellors; Geraldine McGinty, MD, FACR, board of chancellors vice-chair; Ezequiel Silva III, MD, FACR, chair of the ACR Commission on Economics; and other ACR leaders offered advice on how to comply with MACRA final rules, which were announced Oct. 14 and how to cope with MACRA implementation, which begins Jan. 1, 2017.

During a Monday morning session on “MACRA: Radiology Tools for Success,” Silva noted in his lecture that radiologists have known for some time that they can find a pathway to MACRA compliance by either participating in an approved alternative payment model or Medicare’s Merit-based Incentive Payment System (MIPS). However, the MACRA final rule, recent Centers for Medicare & Medicaid Services (CMS) communications and the ACR’s own internal analysis strongly suggest most radiologists will be evaluated under MIPS in year one,” he said.

“It is important for radiologists to understand that MACRA rules applied by CMS’ Quality Payment Program (QPP) will begin evaluating their performance on Jan. 1, 2017 and will begin to affect their Medicare payments in 2019. All physicians will be scored on a scale from zero to 100 based on success in specific performance categories through measures geared to their medical specialties. Higher scores will generate higher payments and the public’s perception of higher quality,” Silva said.

“But, QPP won’t simply encourage physicians and their practices to attain high scores. CMS has said practitioners can pick their pace toward increased QPP participation. By Jan. 1, radiologists must choose a pace ranging from all-out commitment to a more circumscribed approach allowing radiologists to test QPP’s waters before diving in,” he said.

Silva was joined by Frank J. Rybicki, MD, PhD; Mythreyi Bhargavan-Chatfield, PhD; and J. Raymond Geis, MD. Rybicki delved into the process of metrics development including steps that will be taken to assess their appropriateness, measure their accuracy and identify how the resulting data will be collected and assessed. Bhargavan-Chatfield examined the prospects for radiology’s participation in QPP data registries and Geis discussed informatics tools that may be put into place.

On Tuesday, Brink moderated a session on “Prospering in the Era of Payment Reform” covering lectures by Silva recommending how to radiologists should deal with MACRA mandates, by McGinty on the Imaging 3.0 theme of increasing radiologist visibility and involving patients in their radiological care, and Brink’s own presentation on the radiologist’s role in in population health management.

During Wednesday’s morning session on Will MACRA and MIPS Kill Your Practice?, moderator David Levin, MD, FACR, was joined by Silva and Geis to discuss why MACRA and MIPS do not threaten radiology’s survival. Silva considered MACRA within a historical context, referencing a time 30 years ago when policymakers sought to implement payment policy which would have threatened radiology’s independence as a specialty. He described how we were successful then, and how we will be so again under MACRA. He also revisited the “pick your pace” issue also addressed on Monday. Here he framed it in a way to help radiologists to make knowledgeable determinations about their potentially most effective approach.

On Wednesday afternoon, the scope of MACRA and radiology was expanded to their implications for hospital and health system administration in a session entitled “Positioning Radiology for Success under MIPS.” Silva’s presentation emphasized MACRA’s likely effect on facility, hospital and hospital clinic payment. He stressed the importance of collaborations between radiologists and their health care facilities to create synergies enabling both parties and their patients to benefit.

In addition, Diego, R. Martin, MD, PhD, described how a streamlined body MRI application can add value to APMs, and Mark D. Hiatt, MD, MBA, considered the potential impact of increased price transparency on hospitals, imaging centers and radiologists.

In general terms, Silva was pleased that he and his ACR colleagues could present material that was so new and relevant to radiologists because of the recent released MACRA final rule and upcoming implementation date.

“The timing of all this was coincidental,” he said, “but it just added to the power of our message and its importance for radiologists.”