The annual ACR Economics Forum tackled myriad challenges facing radiology in the ever-evolving landscape of U.S. healthcare, with presenters offering solutions and calls to action.
The forum kicked off with the annual presentation of the William T. Thorwarth Jr., MD, Award for excellence in economics and health policy. This year’s honoree was Ezequiel “Zeke” Silva III, MD, FACR, of San Antonio, Texas. Silva is an icon of radiology economics and well deserving of the highest honor offered by the ACR Commission on Economics.
The forum was presented in a panel discussion format, with the first panel tackling issues such as medical necessity, Medicare structure and dysfunctional U.S. healthcare laws. Sammy Chu, MD, FACR, chair of the ACR CAC Network, explained how Medicare is divided into jurisdictions, each of which is assigned to Medicare Administrative Contractors (MACs). These contractors have some freedom to determine the medical necessity of services provided to Medicare beneficiaries. Recent changes to the MAC process have led to marginalization of stakeholder input, which the ACR has fought against by forming multispecialty collaboratives.
ACR Secretary-Treasurer Dana H. Smetherman, MD, MPH, MBA, FACR, discussed what it takes to qualify as a screening study in the Medicare Physician Fee Schedule (MPFS) and reminded the audience that state statutes and regulations do not have authority over federally regulated insurance programs.
ACR Committee on MACRA Chair Lauren P. Nicola, MD, FACR, summarized the dysfunctional Medicare Access and CHIP Reauthorization Act of 2015, which implemented the Merit-Based Incentive Payment System, a deeply flawed pay-for-performance system woven into Medicare fee-for-service. The program ties clinician reimbursement to performance on a set of measures in the domains of quality and efficiency. She highlighted the program’s most glaring flaw of unfair measure options among medical specialties, leading to differential payments based on measure availability and not performance.
Richard E. Heller, MD, MBA, FACR, wrapped up the first panel expounding on the numerous lawsuits and regulator overreaches experienced thus far around the No Surprises Act. He highlighted the inaccessibility of arbitrators granted authority to handle payment disputes between providers and payers, as well as the opaque calculations behind the Qualified Payment Amount (QPA), a key reimbursement benchmark.
The forum showcased the amazing work the ACR staff, supported by volunteers, performs daily on behalf of the College’s membership.
The second panel focused on radiology payments and disruptors. Andrew K. Moriarity, MD, skillfully explained the MPFS reimbursement formula, including the Conversion Factor, and explored the difficulties of using such a formula in a budget-neutral system. He pointed out that physician payments have received no significant correction for inflation in 22 years.
His discussion set the stage for ACR Hill Day. Held at the end of ACR 2023, the event gathered members to visit Capitol Hill and lobby Congress to support H.R. 2474: Strengthening Medicare for Patients and Providers Act, a bill that would update the Conversion Factor according to a healthcare surrogate index for inflation, the Medicare Economic Index (MEI).
Michael S. Booker, MD, MBA, followed with a second call to action, asking members to be on the lookout for a vital survey on practice expense administered by the AMA. He educated attendees on how Medicare practice expense is constructed of both direct and indirect inputs.
While direct expenses (such as supplies, equipment and clinical labor) are allocated for each service, indirect expenses (such as rent and salaries for non-clinical office staff) are allocated across all services. These indirect expenses have not been updated for more than 15 years. Significant redistribution of dollars between clinicians can occur if Medicare accepts the survey results.
Switching gears to radiology disrupters, Melissa L. Chen, MD, struck back at critics regarding the lack of reimbursement for AI applications. Radiologists want to use this technology to improve patient care, Chen explained, but we are pleading with vendors to make more useful algorithms instead of duplicating work already underway. This was sage advice as she also explained how achieving a Current Procedural Terminology code — a vital piece for obtaining reimbursement in the MPFS — necessitates offering a new service not currently described by other services in the fee schedule. Chen also warned that budget neutrality has stymied innovation, creating another barrier to encouraging this vital technology.
Kurt A. Schoppe, MD, wrapped up the forum with discussion on non-physician providers and a recent Medicare ruling that permanently allows these providers to monitor contrast injection in physician offices, but not in independent diagnostic testing facilities, subject to state laws and regulations. The ACR had supported this position.
The forum showcased the amazing work the ACR staff, supported by volunteers, performs daily on behalf of the College’s membership. Many thanks to the staff and volunteers for all their hard work!