Gregory N. Nicola, MD, FACR, Chair of American College of Radiology® (ACR®) Commission on Economics, contributed this post.
I recently moderated the ACR 2022® Economics Forum. The session, which included many great speakers, covered multiple topics, including the No Surprises Act, the Merit-Based Incentive Payment System (MIPS), the Contractor Advisory Committee (CAC) Network, potential technical payment revisions and radiology artificial intelligence (AI).
Discussion of the disappointing interim final rule released by the Centers for Medicare and Medicaid Services to implement the No Surprises Act was especially timely. It has been used to empower insurers to drastically cut provider reimbursement, narrow medical networks and restrict patient access to their chosen providers, including radiologists.
Richard E. Heller III, MD, MBA, spoke about the ACR and its “exceptionally proactive” work on this issue — including its joint lawsuit with the American College of Emergency Physicians and the American Society of Anesthesiologists to block implementation of parts of the Surprise Billing final rule regarding the independent dispute resolution process to determine fair payment for out-of-network emergency care.
Lauren P. Nicola, MD, said that the ACR has been addressing MIPS by actively producing new measures specific to radiology that allow our members to continue successful reporting through the ACR Qualified Clinical Data Registry.
Sammy Chu, MD, FACR, briefed the audience on the ACR CAC Network. Dr. Chu noted that local coverage determination (LCD) policies are set by the Medicare Administrative Contractor. He added that members of the ACR CAC Network continue to play a critical role in the LCD development process and other proposed policy changes despite substantive changes to how the CAC operates.
Michael S. Booker, MD, and Joshua A. Hirsch, MD, tackled the difficult formulas which underlie physician practice expense vital for calculating technical payments for imaging equipment and essential staff. Dr. Booker discussed the shortcomings of past calculations of indirect practice expense and stressed how future calculation will hinge on adequate and accurate data from practice leaders who understand the complex financial questions likely to be in a potential survey for future resetting of these expanses.
Kurt A. Schoppe, MD, and Andy K. Moriarity, MD, addressed direct and indirect threats to radiology RVUs. Dr. Moriarity stressed that bundling of radiology services remains a significant threat, while Dr. Schoppe addressed how budget neutrality required in the Medicare Physician Fee Schedule stymies innovation.
The forum wrapped with a discussion regarding artificial intelligence and its use in radiology. Melissa M. Chen, MD, explained that there are currently two types of AI uses that get reimbursed — care coordination and democratization of care. Dr. Chen added that AI works best when directed by a radiologist. She said this beginning stage of AI use is an opportunity for radiologists to evolve as masters of these tools, and radiologists should incorporate those that allow them to provide the best possible patient care.
Special thanks to all who took part.