The James M. Moorefield, MD, Economics Fellowship offers a behind-the-scenes look at the advocacy and policymaking work that shapes the practice of radiology.
The work that goes into creating a Current Procedural Terminology (CPT®) code is leagues more involved than I imagined, and I am grateful that radiologists and our patients have a designated team of advocates to promote our representation within the AMA CPT Editorial Panel process and in medicine at large.
The ACR’s James M. Moorefield, MD, Economics Fellowship, sponsored by the ACR Economics and Health Policy Department, was an immersive experience in advocacy and policymaking in radiology. The CPT Editorial Panel and Relative Value Scale Update Committee together comprise a group that discusses what may be considered a billable procedure and how that procedure is reimbursed. This has wide-reaching implications for reimbursement and provides a standardized coding language that enables providers to report these services and payers a mechanism to process and reimburse claims.
The fellowship experience itself closely acquaints fellows with the goings-on at the College. The first week is jam-packed with learning about recent wins and current efforts in advocacy initiatives, volunteer opportunities, coverage issues and public health research. There are opportunities to interact with professionals across the ACR, including researchers from the Harvey L. Neiman Health Policy Institute® and members of the ACR executive leadership team.
Through this experience, I learned that physician participation within the Commission on Economics is volunteer work. Dues for the College, in part, go towards paying for the staff that sustain the Commissions on Economics and Government Relations which allow the ACR to advocate on behalf of all patients and radiologists in the U.S. The College’s CPT team creates and revises codes — a feat of advocacy for radiology. The team members review all submitted CPT Code Change Applications (CCAs) to identify and analyze those which pertain to radiology. The dizzying number and breadth of CCAs — in addition to writing and editing our own codes — make getting the entire team be on the same page a remarkable accomplishment. For the CPT team to have a good attitude and teach Moorefield fellows throughout this process is even more impressive. A key part of that experience is learning from Mark D. Alson, MD, FACR, RCC, CPT Advisor, whose extensive knowledge of the CPT process and willingness to share his expertise make him an invaluable mentor. Maria Tran, ACR director of economic policy, will be the first to tell you that sitting next to Dr. Alson at the meeting is quite the experience and not something to be missed. I imagine any Moorefield fellow, let alone any member of the CPT team, would say as much.
In order to warrant its own code, a CPT code should suggest something sufficiently different from what is currently described in the CPT code set.
Listening to discussions about CPT codes is more interesting than it may sound at first. Trying to describe the novelty in new technology on a public stage at a national level appears to be as terrifying as it sounds. The discussions spanned many topics, including wordsmithing, debating the novelty of a new procedure and concerns over access to treatment. In order to warrant its own code, a CPT code should suggest something sufficiently different from what is currently described in the CPT code set. It should also speak to what counts as healthcare in the eyes of insurance. The necessity of specificity was also remarkable, as I had not imagined the uncertainty an incomplete list of examples could sow in the mind of the reader. Conversely, it is surprising the energy spent on seemingly inconsequential changes in sentence structure that feel more on the level of style rather than a significant change in meaning.
Outside of the CPT Editorial Panel meeting, there were meetings with other specialties and vendors to tackle daunting tasks like identifying which specialties perform a procedure and should be involved in the CCA process. Sometimes these discussions were heated, but engagement like this is necessary for preserving the integrity of radiology and patient care. For example, if medical images are involved in a proposed CPT code, it serves both parties well to have radiologists on board.
Overall, the Moorefield Fellowship provided a unique and valuable perspective on the advocacy, policy, and collaborative work that shapes the practice of radiology. Witnessing the dedication of the ACR staff, physician volunteers and specialty society representatives firsthand reinforced the importance of active physician engagement in these processes. I left the experience with a deeper appreciation for the work that goes on behind the scenes to ensure radiologists have a voice in medicine and that patients continue to have access to high-quality, innovative care.
The Root Act: Why Radiology Advocacy in Action Matters
Featured speakers at the ACR Washington, DC Metro Chapter’s inaugural advocacy session highlighted the College’s work as the voice of radiology on Capitol Hill.
Read more
Access on the Go
The emergence of mobile lung cancer screening has given patients better access to the care they need, while reducing screening disparities.
Read more
ACR Supports Radiation Therapy
ACR, ASTRO and ACRO agree that relying on legacy HOPPS cost distributions will irreparably harm freestanding radiation centers.
Read more
