By refining processes, growing volunteer participation and improving collaboration with CMS, the College is ensuring radiology remains integral to value-based care.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
Gregory N. Nicola, MD, FACR
By Nadja Kadom, MD, FACR, member of the ACR Commission on Quality and Safety
Guest Columnist
Kadom would like to acknowledge the roles of Samantha Shugarman, ACR director of Quality Programs, and Judy Burleson, ACR vice president of Quality Management Programs, in the development of this column.
ACR plays a pivotal role in shaping quality measures for CMS’s Quality Payment Program (QPP). These measures are essential for radiology practices navigating CMS’s Merit-Based Incentive Payment System (MIPS), which ties reimbursement to value rather than volume.
Under the Medicare Access and CHIP Reauthorization Act of 2015, CMS transitioned from the Sustainable Growth Rate formula to QPP, emphasizing outcomes, efficiency and value. Since radiologists are often exempt from cost and interoperability categories, their performance in quality and improvement activities largely determine their success. Practices must report six quality measures, including one outcome or high-priority measure, and submit data for 75% of eligible cases. CMS is also introducing MIPS Value Pathways (MVPs), which bundle specialty-specific measures to streamline reporting.
These measures are essential for radiology practices navigating CMS’s Merit-Based Incentive Payment System (MIPS), which ties reimbursement to value rather than volume.
To meet these demands, the ACR Metrics Committee has formalized a five-stage measure development process aligned with CMS’s blueprint:
Despite progress, barriers persist. Development timelines often exceed one year, sometimes up to 22 months, due to limited volunteer capacity and competing clinical demands. Recruiting radiologists for nonclinical roles remains difficult, even with initiatives like ACR’s E. Stephen Amis, Jr., MD, Fellowship in Quality and Safety and outreach at the College’s Quality and Safety + Informatics Conference.
Topped-out measures, which happen when clinicians reporting a particular measure consistently achieve the highest performance scores, are frequently an issue because high-performing practices may dominate reporting, particularly for new measures. This creates a paradox — success leads to removal, even when widespread adoption lags. Additionally, financial and administrative burdens can deter smaller practices from participating. While patients have contributed to past Metrics Committee efforts, they are not included in the committee roster — an area ripe for improvement.
CMS plans to make the MIPS part of QPP more streamlined and meaningful through MVPs. Meanwhile, ACR is developing MVP-compatible measures and working with other measure developers to ensure ACR members’ success. The ACR MIPS Qualified Clinical Data Registry enables measure submission to CMS, including ACR’s and those from other specialties and developers, for use by multispecialty groups and hospital physician organizations. ACR Connect (the vital platform for data exchange, registry participation and AI development) is already deployed in many health systems throughout the country for participants in the ACR Dose Index Registry and Assess-AI. This platform can be used for reporting measures to the QPP regardless of the measure steward or intended specialty.
ACR’s commitment to quality measure development for use in QPP is unwavering. By refining processes, expanding volunteer participation and strengthening collaboration with CMS, the Metrics Committee aims to ensure radiology remains integral to value-based care. As healthcare evolves, these efforts will help radiologists not only meet regulatory requirements but also deliver safer, more effective quality care.
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