May 24, 2019

ACR Economics Forum Delves into Radiologist Payment Policies

The perennially popular Economics Forum at the American College of Radiology (ACR) 2019 Annual Meeting May 20 in Washington, DC, focused on core payment policies under the Medicare and CHIP Reauthorization Act (MACRA), CPT code valuation, the work of the AMA/Specialty Society Relative Value Update Committee (RUC), Medicaid payments and other topics.

ACR Commission on Economics Chair Ezequiel Silva, MD, FACR moderated the forum. His leadership played a critical role in the success of the forum.

As the ACR’s advisor to the RUC, Kurt Schoppe, MD, discussed the Hospital Outpatient Prospective Payment System (HOPPS), which, he noted, few people really understand.

“It’s the payment schedule that loves to be ignored,” he said while noting that HOPPS’ role in reimbursement policy is becoming more important. Schoppe advised radiologists to take an active role in hospital cost reporting, to educate themselves using ACR resources and to act now by raising concerns with hospital finance departments.

Eric Rubin, MD, a member of ACR Coding and Nomenclature Committee, talked about the College’s work on CPT code valuation. He stressed the need to protect existing code valuations and to work to ensure new codes accurately describe the work being done. He used a new 2019 code for contrast-enhanced ultrasound as an example of a positive new valuation. Rubin also posed the question: Why are there no CPT codes for AI?

Lauren Golding, MD, vice chair of the ACR MACRA Committee, was recently named alternate advisor to the RUC. She described some of the current challenges the ACR is facing in light of the 2019 fee schedule, including CMS’ rejection of many RUC recommendations for radiology codes.

Golding also highlighted Anthem, the largest for-profit, managed care, health insurance company in the Blue Cross Blue Shield Association. Anthem’s nomination of seven high-volume codes as potentially misvalued could be seen as a conflict of interest in attempt to influence Medicare physician reimbursement rates. “This could be a big win for their bottom line but a big loss for physicians and for patients,” she said.

Raymond Tu, MD, is CPT advisor for the American Society of Neuroradiology, a RUC advisor for the American Roentgen Ray Society and the ACR’s Medicaid Network chair. Tu talked about the ACR’s efforts to advance Medicaid policy. He reviewed the “10 Essentials of Medicaid,” and praised the ACR’s Engage platform as critical to raising member awareness about the importance of Medicaid to millions of people.

“Feeding us content on Engage will help us better run the program,” he said.

Robert K. Zeman, MD, FSAR, FACR, chair of the department of radiology and radiation oncology at the George Washington University, described the important work of the ACR’s Radiology, Radiation Oncology and Nuclear Medicine Carrier Advisory Committee (CAC) Network, as well as Medicare coverage issues, such as updates for lung cancer screening, PET/CT and CT colonography.

Zeman thanked ACR Economics Commission volunteers and staff and CAC representatives and state chapters for work he called an important part of the ACR’s overall coverage strategy. “It’s a regional effort, and we couldn’t do it without you,” he said.

Gregory N. Nicola, MD, vice chair of the Commission on Economics and chair of the ACR MACRA Committee, concluded the first half of the economics forum with a MACRA update about performance category scoring. He noted participation in MIPS has been made easy because of the way scoring has been set up. Moving forward, he believes “we can show that we’re doing our best.”

But radiologist participation in Advanced Practice Models (APMs) could lead to undesirable results. “Radiology hitchhiking — when you are in an APM and assume that your organization is taking care of your interests and you don’t need to do anything — is a serious misconception, and the wrong move,” he stressed.