Through a global pandemic, pressure on the Medicare conversion factor, the emergence of AI and more, the ACR Commission on Economics did not just react — it led.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
This is my final column as chair of the ACR Commission on Economics. After six years in this role, I have reached my term limit, and it is time to pass the gavel. What began as a tremendous honor has become one of the most meaningful chapters of my professional life. I want to use this last column to reflect on what we accomplished together, to thank the people who made it possible and to introduce the next leader who will carry this mission forward.
When I became chair in 2020, I inherited a commission with a proud legacy, shaped by leaders like Geraldine B. McGinty, MD, MBA, FACR, and Ezequiel Silva III, MD, FACR. I set out with clear guiding principles: protect radiology’s place in fee-for-service payment systems while preparing our specialty for the transition to value-based care. Over these six years, the healthcare landscape shifted dramatically — through a global pandemic, relentless downward pressure on the Medicare conversion factor, the emergence of artificial intelligence and sweeping regulatory change. Through it all, this commission did not simply react, it led.
Among our proudest accomplishments is the sixteen-year advocacy effort that finally secured CMS coverage of CT colonography for colorectal cancer screening, effective Jan. 1, 2025. We reformed the Merit-Based Incentive Payment System scoring methodology, so radiologists are no longer unfairly penalized for a lack of specialty-specific quality measures. We defended radiology valuations at the AMA/Specialty Society Relative Value Scale Update Committee (RUC), converting Category III tracking CPT® codes — such as cerebral CT perfusion — into permanent Category I codes. The ACR led the successful CPT code change application that created six new MRI safety codes which became effective in 2025. These provided reimbursement for the critical work of assessing and managing patients with implants and foreign bodies in the MR environment — work that had gone uncompensated for years. We launched the ACR’s AI Economics Committee to develop reimbursement strategies for AI tools in radiologic care. We extended virtual direct supervision policy for contrast administration, expanding patient access in rural communities. These are just a few of the many tangible accomplishments of your ACR economics team.
Among our proudest accomplishments is the sixteen-year advocacy effort that finally secured CMS coverage of CT colonography for colorectal cancer screening.
I have also had the privilege of serving on the RUC, where I represent radiology on the multispecialty panel that recommends physician work values to CMS. I first began attending RUC meetings as the American Society of Neuroradiology advisor in 2010 and eventually transitioned to the radiology seat on the panel. This work is painstaking, technical and often conducted far from the spotlight, but it is foundational. Every RVU assigned to a radiology CPT code directly affects what radiologists are paid and whether patients have access to imaging services. Advocating for fair valuation at the RUC has been among the most consequential work of my career.
None of this would have been possible without the countless volunteer physicians who serve on the commission’s committees. These radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists donate countless hours reviewing proposed rules, preparing RUC presentations, analyzing payment data and testifying before policymakers. To every volunteer: your dedication is the engine that drives this commission, and I am profoundly grateful. I must equally recognize the extraordinary ACR staff — our economic policy, government relations and quality and safety teams — whose tireless professionalism translates complex regulation into actionable strategy.
It is with great confidence that I introduce the next chair of the Commission on Economics: Lauren P. Nicola, MD, FACR. Nicola is the CEO of Triad Radiology Associates, a physician-owned private practice in Winston-Salem, N.C. She is board certified in diagnostic radiology with subspecialty expertise in pediatric and breast imaging. She has served as chair of the ACR Commission on Ultrasound and as a member of the Board of Chancellors. Nicola has chaired both the Reimbursement and MACRA committees within our commission and served as the ACR’s RUC Advisor. She is a nationally recognized expert in healthcare reimbursement policy and a prolific researcher on Medicare payment trends, MIPS performance and the economics of AI in radiology. She was universally chosen as the next chair by our many volunteers, staff and leadership, and is the right person at the right time.
The challenges ahead are real: a Medicare conversion factor that has lost tremendous ground to inflation, workforce shortages, the need to build an AI reimbursement framework and continued vigilance against policies that undervalue our specialty. But I leave this chair more optimistic than when I started, because I know the quality of the people who will continue this fight. Thank you for the privilege of serving as your chair. It has been the honor of my professional life.
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