It takes a visionary to see the future, which is why the ACR invited advertising industry legend Rosemarie Ryan to start Economics Forum — Part 1. Ryan’s specialty is product branding including the creation of indelible corporate identities that build consumer loyalty and increase product sales. McGinty says rebranding may be counter-intuitive for some radiologists, but learning to tell the story of radiology’s contribution to effective and efficient medicine is essential to cultivating relationships with physicians, patients and families and for exerting influence on decision-makers who control access to resources for their practices.
The forum will then move on to radiology payment issues in presentations by radiologists who have been assigned responsibility for some of the ACR’s most important economic functions.
Daniel Picus, MD, FACR, is the College’s representative on the American Medical Association’s (AMA’s) CPT Code Editorial Panel and chair of the College’s Economics Committee on Coding and Nomenclature. In What’s Happening to Fee for Service, he will describe his efforts on the panel, with assistance from ACR staff, to maintain a set of CPT billing codes that comprehensively expresses a full range of radiological applications.
The ACR is fighting against edits by the Centers for Medicare and Medicaid Services that place incorrect payment restrictions on particular CPT codes, he says. In recent years, the College has emphasized the importance of training and preparation for ICD-10 disease codes implementation.
Picus will stress that fee-for-service is still the primary payment model for radiological services, and he will describe how the College is working to make sure its members are reimbursed fairly by government and private payers for their work.
For appropriate procedural valuation, the College looks to Ezequiel Silva, III, MD, FACR, its designated advisor to the AMA/Specialty Relative Value Scale Update Committee. In his session on Value-Based Payments, Silva will provide a dollars-and-cents analysis of recent actions by Congress and CMS to move Medicare from fee-for-service reimbursement to new systems of value-based and quality-driven payments for physician services.
The blueprint guiding this transition was described in the Medicare Access and CHIP Reauthorization (MACRA) Act. Congress enacted the legislation, which also repealed Medicare’s failed Sustainable Growth Rate policy, in April 2015. The law creates two parallel tracks for future Medicare physician payment. One is through participation in an alternative payment model, such as an accountable care organization (ACO). The other is a merit-based incentive payment system (MIPS). It uses a modified fee-for-service formula with bonuses and penalties that adjust for physician performance. The implications of these systems for radiologists will form the basis of Silva’s lecture on Monday and again on Thursday when he teams with Gregory Nicola, MD, for an hour-long session entitled “From PQRS to MIPS: What You Need to Know About New Payment Models for Radiology.”
- The Patient as Payer — James V. Rawson, MD, FACR, chair of the ACR Committee on Government and Regulatory Issues in Academic Radiology, on how patients are thinking more about how they pay and what they pay for health care
- Turning Research into Payment Policy — Richard Duszak, MD, FACR, chief medical officer of the Harvey L. Neiman Health Policy Institute®, on the importance of research for developing new imaging technologies and establishing their clinical efficacy to quality them for reimbursement
- Why Medicaid is Important — Raymond Tu, MD, FACR, chair of the ACR Medicaid Network, on Medicaid’s past as a vehicle of desegregation and future as an instrument for expanded health care access with all physicians becoming stewards and beneficiaries of this important program
- Commercial Payers/Employers — Geraldine McGinty, MD, FACR, on how commercial payers are increasing adopting ACOs and shared saving models
- Influencing Payment Policy in New Ways, the Radiologists of 2022 — McGinty on how the future of radiology practices will build on the College’s Imaging 3.0 story by encouraging radiologists to become more visible and involved in health system governance
At past conferences, the ACR would have emphasized its notable successes, such as the Congressional rollback of the Medicare’s erroneous multiple procedure payment reduction (MPPR) for the professional component of advanced imaging. McGinty still wants make sure ACR members appreciate the breadth and volume of work the ACR Commission on Economics and the College’s staff does on their behalf.
“But we are not going to dwell on what we have done,” she says. “We are going to stress what we are going to be thinking about as we go forward in the future.”
The Economics Forum — Parts 1 and 2 — are two of 22 sessions devoted to the Advocacy, Economics and Health Policy Pathway at ACR 2016 – The Crossroads of Radiology®. Visit the Annual Meeting webpage to register.