For many years, medicine has seen a shift toward value-based physician reimbursement. As part of the Imaging 3.0® initiative, which was launched to help radiologists make this transition, ACR formed the Commission on Patient- and Family-Centered Care (PFCC). Comprised of six committees, the PFCC’s mission is to encourage radiologists and the ACR to place the patient at the center of imaging care. One of these committees, the PFCC Economics Committee, strives to inform economic policy with the patient firmly in mind. As such, a key component of the committee’s work involves supporting the creation of metrics to measure how well radiologists are adopting patient-centered practices.
One growing area of metric development involves patient-reported outcomes data, which has become a focus for the committee. Such data collection efforts seek to ascertain what the patient most values, not what physicians think they should. For a variety of reasons, however, the radiology profession has not made the collection of patient-reported outcomes data a priority. As James V. Rawson, MD, FACR, PFCC chair, writes, “Traditionally, these metrics are obtained from patients by means of surveys and tend to be more lifestyle focused. These surveys are more than just patient satisfaction surveys, however.”
he importance of such measures was recently highlighted in the CMS CY 2020 Medicare Physician Fee Schedule Proposed Rule, in which CMS requested public comments on significant changes to its Quality Payment Program (QPP). In particular, the agency sought comments on incorporating more patient-reported outcomes and care experience measures into a modified version of the Merit-Based Incentive Payment System (MIPS) — also called the MIPS Value Pathways, or MVPs.
The MVPs are a proposed series of refinements to previous iterations of MIPS, which had required clinicians to report on many different measures across multiple performance categories. At this point, MVPs are a conceptual alternative, and CMS is continuing to gather stakeholder input on their potential implementation. The MVPs may invite clinicians to report only a few measures — establishing a more straightforward path for participation in MIPS and potentially a better glide path toward alternative payment model (APM) participation. As part of the rollout, CMS requested information on patient experience and satisfaction measurement tools or approaches to capturing patient-centered information that would be appropriate for inclusion in MVPs.
In response to this change, on Sept. 23, the ACR submitted comments to CMS responding to multiple components of the Proposed Rule. These comments included those developed by physician volunteers from the Commission on Economics and the Economics Committee on MACRA; staff from ACR’s economics, quality and safety, and government relations departments; and physician leaders from the PFCC Economics Committee. In terms of the PFCC’s contribution, the effort was led by Melissa M. Chen, MD, chair of the committee, and was supported by staff from the ACR’s Center of Excellence on Environmental Intelligence. According to Chen, “The request in the Proposed Rule offered an opportunity for us to support efforts by CMS to create pathways for the development of patient surveys and patient-reported outcomes.”
CMS’ focus on patient-centered metrics and outcomes coincided with efforts already underway in the committee to develop a focus group and survey to capture patient-reported outcomes data related to diagnostic mammography. The focus group — comprised of former and current mammography patients — will help inform the development of survey questions, which will, in turn, evaluate radiologist performance based on what patients most value in their breast imaging experience.
At the conclusion of the focus group, physician volunteers will be in charge of developing survey questions based on participant feedback. These same physicians will administer the finished survey to their breast imaging patients, gathering patient-reported outcomes data along the way. Going forward, this survey could be adopted by breast imagers nationwide to help ensure quality patient care. The committee’s ultimate hope is that the survey produces patient-reported outcomes data from which metrics specific to radiology can be created. Regardless of refinements CMS may make to MIPS, MVPs, and APMs, patient-reported outcomes will remain a primary focus. This survey will be a tool for radiologists to demonstrate their value in delivering patient-centered care.