Outgoing Chair Gregory N. Nicola, MD, FACR, reflects on recent wins — and his hopes for the future of the Commission and the specialty.
For the past six years, Gregory N. Nicola, MD, FACR, has served as chair of the Commission on Economics, combining his passion for working with his peers with his goal to make an impact on economics in radiology. Nicola, who currently serves as an executive leader of the Hackensack Radiology Group in Hackensack, New Jersey, as well as board member and finance chair for the Hackensack Meridian Health Partners Clinically Integrated Network, is a leader in the radiology community specifically on health policy and economics issues. He serves as AMA RUC panel member for the ACR and is a past two-time participant of the CMS/Acumen Resource Use Measure Committee. Aside from his leadership roles, he has authored and co-authored numerous peer-reviewed articles pertaining to health policy and economics and is a frequently invited speaker at national medical conferences.
As ACR 2026 approaches, Nicola spoke with Bulletin staff about the Commission’s numerous accomplishments from advancing CT colonography payments from Medicare to implementation of MR codes. He also reflected on his time as chair of the Commission and shared what he hopes to see accomplished in the future.
I had joined a private practice and started looking at billing and coding. At the time there was the Physician Quality Reporting System (PQRS) program, which preceded the Merit-based Incentive Payment System, and I noticed that our practice could be more successful if we understood those regulations and learned how to report. So, I started learning about PQRS and then CMS Meaningful Use and really got my practice involved. Then, out of nowhere, I was at American Society of Neuroradiology meeting and got asked to attend an economics meeting. It started to interest me, and I said, “Wow, these are practice issues I’m dealing with every day, and there’s a way to get involved at a national level and shape and understand these issues.” It was really that my own practice needed expertise in it and I ended up learning it. To be honest, I have noticed over the years that the best volunteers are self-motivated because they want to be able to succeed in their own careers on the business side. They are either in a department or practice where there are some opportunities to improve. If the opportunities are economics-related, these volunteers end up finding their way to the economics team and adding significant value.
When you find the right people, you love to teach them — they learn things on their own and grow as professionals. It has been really rewarding to watch.
One of the biggest accomplishments was CT colonography receiving payments from Medicare. That’s years and years of hard work from staff and leaders like Judy Yee, MD, FACR, chair of the ACR Colon Cancer Committee. There are a lot of Americans who do not have access to CT colonography. I think it has leveled the playing field on being able to be screened for colon cancer. The access issue hasn’t been solved, but it has narrowed that gap. Another huge accomplishment was the implementation of the MR safety codes. I’m glad that the MR physicists, our CPT® team and a number of experts brought that code family forward to capture the value of work that our medical physicists, our radiologic technologists and radiologists were doing that wasn't being captured in real-world payments.
One of the most rewarding things I've done was to help find the next generation of advocates and get them in a position to do amazing things. When you find the right people, you to teach them — they learn things on their own and grow as professionals. It has been really rewarding to watch.
It’s tough to pick one issue. The ultimate issue facing the profession is the application of AI. I think this is such a vital issue, because the ACR can play an enormous role in shaping what radiology can look like in the future. AI could lead radiology to becoming a completely different profession in five to 10 years and people like me can only shape it so much. We need those early-career professionals who are going to be in this field for 20 or 30 years to shape it further.
Another has been making sure there’s better access to screening. There are several advocates who have taken on the role of trying to get rid of cost-sharing, not only in mammography, but in CT colonography and lung cancer screening. What I mean by that is, yes, the initial screening study is paid for by the payers, but the downstream cost of biopsy or further workups is not and that’s been a deterrent for patients. This is particularly true for patients who know something might be found and the financial worries that come with it. I do think we need to do more work around removing those cost-sharing barriers to those patients, and I would like to see the next chair advocate harder for that aspect of care.
The whole impetus is how do we shape the new activities radiologists are doing by capturing the value through payable codes. I needed a committee comprised of not only experts in quality and safety, and the technology itself, but who understood what’s a payable activity by a radiologist. We needed a workgroup that had experts from all the domains to be able to answer those questions holistically, instead of just from an informatics point of view, or just from a quality and safety point of view or just from an economics point of view. So, the whole point of the AI Economics Committee is to bring together experts in quality and safety, informatics and coding. We needed to talk about how we are doing this new task that we’ve never done before because AI has been implemented and we’re not necessarily getting paid for that task. The topics range from monitoring the output of AI to reconciling differences in AI to making sure there’s no data drift. The committee will also be looking at a number of requests for information put out by disparate organizations in our government and others that ask about AI applications.
These young physicians have the chance to shape the specialty they’ll be working in. There may be more leadership roles for radiologists in AI than there were in the past. I think the next generation needs to develop leadership skills, and there's no better place to do that than in the College. They need the language of economics and AI to get those leadership skills. Lastly, they need to shape the profession, and that can be done through volunteerism and advocacy. It's vital that they get involved early.
I think one of the most drastic problems we have now is the budget neutrality mandate from Medicare. The main problem is it is absolutely stifling innovation in the Medicare Physician Fee Schedule (MPFS). We have an issue where hospitals have all the resources to implement AI and physician practices don't, because there isn't any new money for them, and there aren’t reimbursement policies that are conducive to AI in the MPFS. Hospitals are moving towards the next generation and physician practices can't, and it's causing potentially more employment of physician groups, and less employment of independent practices. Private practices might not have the same technology as an owned practice. It's an issue that must be solved soon. We can't have two different fee schedules supporting entities that participate in the healthcare of our seniors and other patients in the country.
The incoming chair is going to be loaded with talent and probably be incredible. The best leadership quality is becoming a teammate as a co-learner. None of us on this economics team know everything, and everybody brings something to the table. When you join a team as a leader, you become a co-learner and are excited to learn from your participants, volunteers and/or staff. It’s good to be excited to share what you learned with other people. It intrinsically makes you a better, much more engaged leader. It also becomes a lot more fun to lead. To me, that has been the best lesson of my life.
Interview by Alex Utano, associate editor, ACR Bulletin.
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