ACR 2026 Economics Forum Talks Efficiency, AI, Fair Payment

The Economics Forum at ACR 2026 — the College’s annual meeting — featured updates by Lauren P. Nicola, MD, FACR, incoming Chair of the ACR^® Commission on Economics, Cindy Yuan, MD, PhD, Chair of the Commission’s Economics Committee on Nuclear Medicine, and Frank J. Rybicki, III, MD, PhD, FACR, Chair of ACR’s AI Economics Committee.

Dr. Yuan, updated attendees on how ACR advocacy has been working diligently around the new CMS-deemed “efficiency.”

“For the 2026 year, CMS decided we were all 2.5% more efficient, across all procedures,” said Yuan. “The procedural times and work RVUs [Relative Value Units] were all cut uniformly by 2.5%. So that resulted in this 2% Conversion Factor (CF) increase because if all the wRVU [standardized measurements in healthcare that measure time, skill and intensity needed for a physician to provide a medical service] counts are going down, then the CF can go up by a little bit — which did slightly soften the blow.”

Added Yuan, “The real concern is that CMS said, ‘Maybe we will do this every three years,’ — which means in a few years we might once again be facing some sort of uniform efficiency cuts to wRVUs.”

Dr. Nicola followed with an update on the No Surprises Act (NSA). Over the last six months, there have been 1.9 million disputes registered under the NSA Independent Dispute Resolution (IDR) process, up 39% from the previous six-month period. According to Dr. Nicola, radiology is responsible for 19% of all disputes, with physicians winning 88% of the claims. However, she says when this happens, there is a mandatory Medicare fee, high administrative and legal fees, and delays on physicians getting the award from the dispute. Dr. Nicola dove into how smaller, rural or underfunded practices have difficulty in these scenarios due to complex batching rules that are constantly changing. ACR continues to fight for a fair qualified payment amount, which is considered the median in-network rate. A pending bill, the No Surprises Enforcement Act, would help physicians get paid in a timely manner from insurers after an IDR decision.

Dr. Nicola shifted toward the future of the NSA, including the burden caused by a surging IDR volume. Out-of-network hospitals may get penalized 10% by insurers in non-emergency cases due to an emerging policy — putting pressure on radiology groups to focus on in-network cases. She said the College argues that the policy undermines the NSA and will continue to fight against it.

Dr. Nicola also discussed Medicare Advantage and how CMS is tightening the rules on prior authorization by proposing mandatory electronic prior authorization standard documentation. It likely means quicker turnaround times for approvals, but it could also mean that physicians will have to be more careful about establishing structured data requirements, Dr. Nicola said.

The final ACR 2026 Economics Forum update was from Dr. Rybicki. The AI Economics Committee was launched in 2025 to help consolidate current resources and develop financial strategies for the development and deployment of radiologic AI tools. The Committee addresses Medicare, Medicaid and private insurance coverage and reimbursement for AI. It also works closely with the ACR Data Science Institute^® (DSI), which convenes imaging AI users and thought leaders through its annual DSI Summit and year-round events.

According to Dr. Rybicki, AI may obligate radiology to go “all-in.” Interpretation is the highest bar, he said, and large language models will work to orchestrate around it. “We want to go from a fragmented AI tool to an orchestrated one and I think the DSI has been fantastic about that,” said Dr. Rybicki. “The places where we can use AI effectively and pay for it and be gainful and save money are actually around the interpretation first and at the interpretation level later on.”

So how do we do it? According to Dr. Rybicki, the three keywords are local, secure and private. “Those are three tools, three tenants, that if we think about when deploying AI, we can be very successful. We really need to understand that we can have affordable, effective AI and that ACR members should be informed of what they are because at a minimum, if you know what it is then you realize that it’s not a huge stretch to learn this stuff.”

By Alex Utano, associate editor, and Nicole B. Racadag, publications manager, ACR Bulletin.