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Challenges and Opportunities to Fund the Future Drive Discussions at the ACR 2024 Economics Forum

The session's two-part format first covered payment reform and workforce issues, then highlighted a unique program the College is overseeing that provides tangible and positive safety and business operational improvements.
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When we heard that the Learning Network was doing a project to help institutions improve their lung screening participation, we jumped right in.

—Ben Wandtke, MD, MS
May 08, 2024

Gregory N. Nicola, MD, FACR, chair of the ACR Commission on Economics and part of the executive leadership team at Hackensack Radiology Group, served as the moderator of the ACR 2024 Economics Forum, which explored new payment models for radiation oncology, the challenges of duplicating such models in diagnostic radiology, updates on the Medicare Physician Fee Schedule and reimbursement issues around the current radiology workforce crisis. Speakers included Dave Adler, MA, American Society of Radiation Oncology (ASTRO) vice president of advocacy; Lauren P. Nicola, MD, FACR, chair of the ACR Reimbursement Committee and CEO of Triad Radiology Associates; James M. Milburn, MD, MMM, FACR, chair of the neuroradiology committee for the ACR Commission on Economics, vice chair of the department of radiology and director of neurointerventional services at Ochsner Health System and professor of radiology at the University of Queensland; David B. Larson, MD, MBA, FACR, chair of the ACR Commission on Quality and Safety and professor and executive vice chair of the department of radiology at Stanford University School of Medicine; and Ben Wandtke, MD, MS, vice chair for quality and safety at the University of Rochester Medical Center.

Mr. Adler talked about a new program proposal ASTRO has put forward that he believes is progressive and innovative and will bear fruit (read more in this month’s Economics Chair column). He said ASTRO is trying to address clinical and reimbursement trends in radiation therapy. “These have driven the development of a new payment proposal that we call ROCR, or the Radiation Oncology Case Rate Program,” he said. “The goal with ROCR is to realign payment incentives around high-quality care. I am excited to say that momentum is really building around this policy proposal as we work with stakeholders like the ACR and folks on Capitol Hill.”

“We also saw this as a great opportunity to reduce disparities that we know exist in access to radiation therapy among rural and underserved populations,” Adler said. “We felt like we could do all of this using episode-based payments in a way that lower total Medicare spending, and by extension patient costs.”

Dr. Lauren Nicola talked about alternative payment models (APMs) in diagnostic radiology. She noted the differences between diagnostic radiology and radiation oncology and how those differences impact the opportunities for diagnostic radiologists to participate in APMs. “First and probably the most important one is that the care diagnostic radiologists provide isn’t episode based,” she said. “What that means is that we don’t really have a defined start and end to the care that we provide for a patient. It is difficult to build a payment model around care that is not episode-based.”

The ACR and its coalition of specialties is fighting hard to mitigate those cuts, successfully recovering more than $1.6 billion dollars in reimbursement to radiologists over the past three years.

—Lauren P. Nicola, MD, FACR

She continued speaking about the challenges around the Merit-based Incentive Payment System (MIPS) and fee for service environment for radiologists. On the latter, she said, “We know that Medicare reimbursements have declined, and you have all seen graphs of what has happened to the Conversion Factor over the last couple of decades, especially compared to inflation. The ACR and its coalition of specialties is fighting hard to mitigate those cuts, successfully recovering more than $1.6 billion dollars in reimbursement to radiologists over the past three years.”

Nicola also talked about the No Surprises Act (NSA) which threatens commercial payer contracts across the country. “Many people think that if you’re not an out-of-network physician that the NSA doesn’t impact them,” she said. “But what we have seen and what we have heard from members is that a lot of practices are getting letters from insurance companies saying that you either take across-the-board giant cuts to your rates or you will be thrown out of network.”

Dr. James Milburn spoke to attendees about current workforce challenges, mainly related to the aging population and residency slots. “Luckily, radiology is very popular among medical students, and it is also very competitive,” he said. “We have more applicants than we have radiology positions, and there are a ton of great applicants who don’t match into radiology who could become excellent radiologists,” he said. “It may seem that a simple way to address the workforce shortage would be to increase the number of radiology positions — but it’s not so easy. We must first understand how graduate medical education is funded.”

“A good take home point is that if anyone in the audience is in a teaching program or in a position at their local hospitals to advocate for adding additional residency positions, private funding from your hospitals may be the way to go,” Milburn said. “Because so many future hires originate from our own residency programs, we can argue that privately funding positions through health systems could increase the number of local residents — and these are often our best recruits for future attending staff positions.”

Dr. David Larson opened his discussion with the ACR’s Learning Network and his experience participating in the program. “The Learning Network is a team-based experiential program that does two things simultaneously. One is to train radiologists and staff teams in moderate improvement methods, and two is to facilitate successful improvement,” Larson said. “We train people while at the same time they are making a difference in our organization. We help you at your local site, or local sites put together teams with physician and staff leads,” he noted. “Participants also get the support of a quality improvement coach.”

“To learn more about the program, we encourage you to look at our articles in the JACR® that show results, and to visit the network’s website,” Larson said. “For those of you who are interested in participating, I think you will find the results to be incredibly positive. This is not a moneymaker, but it brings value to the practices it supports,” he said. “It costs very little and provides opportunities for our field and individual practices to make a real difference.”

Dr. Ben Wandtke also spoke about how the Learning Network uses quality improvement methods to help participating sites improve their bottom line. He talked about his group’s participation for the purpose of improving its lung cancer screening program. “We thought our program was doing pretty well,” Wandtke said. “But when we stopped and thought about this a little bit more, we realized that it is inadequate compared to other mature screening programs like those for breast and colon cancer screening.”

“When we heard that the Learning Network was doing a project to help institutions improve their lung screening participation, we jumped right in,” Wandtke said. “What was different about the program is that they helped us build a project team that was more diverse than any quality improvement project I have ever worked on,” he noted. “You have a tremendous opportunity to add value to your health system and for your patients by working on your lung cancer screening and incidental findings management programs by participating in this collaborative network.”

Dr. Gregory Nicola also expressed his appreciation for the important work of the Learning Network. His practice participated in the lung cancer screening cohort and Nicola was the team sponsor. “The LCS collaborative gave our organization the tools needed for reaching and tracking our patients. We came together as a team using these tools to remove barriers limiting patients’ participation in lifesaving technology.” Nicola thanked the speakers and concluded the forum by opening a question-and-answer period for attendees and panelists. Recordings of the 2024 Annual Meeting sessions can be found here

We would love to hear what you think about the issues discussed in this article. If you have questions or comments — or would like to share your own experience with the economics surrounding the workforce crisis — please send them to And don’t forget to explore other ACR Bulletin content, including more coverage of annual meeting sessions and presentations, to stay current on the most important topics in radiology.

Thank you for attending ACR 2024! The ACR is pleased to have accomplished all elements of this year’s annual meeting in a hybrid environment, welcoming over 1,200 attendees in person and virtually.

Election results, final actions of the Council and on-demand recordings of award presentations are currently available. The College will post additional session content in the coming weeks in case you missed anything during the live event. If eligible, you may claim CME online.

If you have questions, please contact

Save the date for ACR 2025May 3–7 in Washington, DC.

Author Chad Hudnall  senior writer, ACR Press