ACR Bulletin

Covering topics relevant to the practice of radiology

Chaos and Opportunities

The ACR Government Relations team moved quickly through 2020 to get the most important member issues heard and addressed.
Jump to Article

The E/M struggle will continue. This is why we need everyone to participate and be engaged in the ACR’s activities.

January 27, 2021

Washington can be an enigma. There may be long periods of relative inactivity, mixed with days or weeks of frenzied chaos. It seemed fitting for the unpredictable trajectory of 2020 that it was the holiday season that brought a frenetic pace to everyone on Capitol Hill.

As you know, our ACR-led coalition was able to mitigate a number of items in the end-of-year COVID-19 legislation. In the short-term, what seemed like an inevitable 10% decrease from Medicare, across radiology, was reduced to about 4%. Physician adverse terms in surprise medical billing were modified so that many of radiology’s goals in the legislation were realized — most importantly, taking patients out of the middle. There were other provisions in the legislation that will benefit us and the patients we serve, including a one-year delay in the implementation of the controversial CMS Radiation Oncology Payment Model, an extension of no-cost screening mammography for women 40 and older, and adjustments to tax consequences for those seeking pandemic-related relief from the Paycheck Protection Program.

There are lessons to be learned from these efforts. Our GR staff astutely realized early in the evaluation and management (E/M) struggle that, as a relatively smaller specialty organization, we could not have sufficient influence acting alone. Through hard work and negotiation, we were able to gather a coalition of more than 80 organizations to stand with us. Remarkably, despite the political ebbs and flows, we were able to hold this coalition together and remain united on our positions. We strengthened many relationships, which will no doubt serve us well in the future. Without the power and influence of our partner organizations, we may have faced a very different outcome.

We also established a new standard for the flow of information between our GR team, economics experts, and consultants. As you can imagine, every iteration of possible legislation had to be translated into impact on our practices. With the multiple parameters in play at times, this was not a straightforward task. The effort helped reinforce relationships and established important lines of communication amongst many stakeholders.

In the short-term, what seemed like an inevitable 10% decrease from Medicare, across radiology, was reduced to about 4%.

Several opportunities were also identified. There were several calls to action that were sent to the membership, mostly via our Radiology Advocacy Network. Despite the urgency and significant impact of E/M on all our practices, we only achieved a 10% response rate. Our efforts were supported by calls from ACR leadership to state chapter presidents urging additional responses. Several Engage and social media posts implored members to respond. Fortunately, we received lots of support from others in the radiology community and our coalition partners. Clearly, we still have work to do to motivate our members and communicate the importance of responding to calls to action.

2020 posed a number of challenges for our advocacy, mostly due to the suspension of activities due to COVID-19. ACRA member support is a vital component to our three-pronged approach to advocacy, which includes RADPAC®, lobbying, and grassroots engagement. Now is the time to emphasize the importance of participating and investing in our future.

Although measured, it was remarkable that we were able to move the legislative momentum in Washington at a formidable time. Everyone’s attention was on other matters, including the polarized politics of the day, COVID-19 legislation, and the Georgia Senate runoffs. Yet, our GR team was able to thread a fine needle to get our issues heard and addressed. Despite the odds, our GR staff once again demonstrated that they are some of the best in a very convoluted and complicated business.

We all need to take this opportunity to realize that sentinel events like these and so many others are the reason we have built a strong College. The E/M struggle will continue. Other issues will come before us. This is why we need everyone to participate and be engaged in the ACR’s activities. This is the value that our College delivers. This is why everyone should be a member of the College.

Author BOC Chair Howard B. Fleishon, MD, MMM, FACR