While radiologists are certainly accountable for the care we provide our patients, what can we do better?
May 26, 2020
As of this writing, the world is still in the grip of the COVID-19 pandemic. I cannot write an economics column without acknowledging the extreme difficulties our patients, members, practices, staff, and families are facing. Radiology and radiologists will survive, and I am sure we will hear countless stories of true leadership within the profession. The College has had a long line of leaders throughout all of its commissions, and I would be remiss if I did not thank my predecessor, Ezequiel “Zeke” Silva III, MD, FACR, for his tremendous dedication to our specialty. Zeke is a unique asset who has and will continue to bolster the position and reputation of radiologists throughout the medical community.
As the new chair of the Commission on Economics, I will lead a team of highly dedicated and skilled ACR volunteers, supported by equally skilled staff. COVID-19 is the first of many challenges we will face. I won’t claim to have all the answers, but I will promise to respect the central thesis of a quote previously attributed to former CMS Administrator Donald M. Berwick, MD. According to the story, Berwick was asked how he planned to transition the massively expensive U.S. healthcare system from fee-for-service (FFS) to value-based. He answered, “There is only one way, and that is to learn our way out of it.”
We are a specialty that will need to learn our way out of many things, including devaluation of our services, lack of accountable quality metrics, inappropriate utilization of imaging, and inconsistent management of incidental findings. These are just a few of many roadblocks we must continue to navigate. I can assure you that the Commission on Economics will lead these charges, while protecting our FFS payments. However, we would be shortsighted not to recognize a mounting tidal wave of change around us, and we must learn how to participate in such change. While the radiologist’s role in alternative payment models (APMs) and the central thesis of Imaging 3.0® help define a path forward to value-based care, they lack the gravitas of a true burning platform that spurs real urgency.
Our profession should heed a valuable lesson learned during the early phases of COVID-19. A sizeable number of those with this virus are asymptomatic carriers. These carriers are helping spread the infection to those at risk of serious respiratory illness. Governments across the globe must define rules and hold their citizens accountable to these rules to stop the spread of this potentially lethal infection. Like the asymptomatic carriers, the argument goes that radiologists have no direct accountability to patient care or well-being. However, similar to the culturally sensitive accountability rules disparate governments are prescribing during the COVID-19 crisis, our accountability may not be as obvious at face value. Yet we must acknowledge and embrace accountability. While radiologists are certainly accountable for the care we provide our patients, what can we do better?
The answer has significant payment implications as it will serve as the cornerstone of our transition to value-based care. Under Zeke’s leadership, this charge has already been formalized. The Commission is actively looking at alternative ways to pay radiologists who practice enhanced forms of accountability, especially in areas of care gaps. For example, who is ultimately responsible and best suited to manage incidental radiographic findings? The answer is complex, but if radiologists are willing to participate, shouldn’t there be ways to financially reward those services?
Unfortunately, more than payment gaps limit our participation in APMs. The College has responded by formulating a multi-pronged and multi-commission approach, including metric development, requesting reversal of regulatory language prohibiting radiologists from ordering downstream studies, and addressing economics and technologic barriers in our local practice. The Commission will continue to fight for you, and together we will learn our way out of any adversity that comes our way.