Syed F. Zaidi, MD, interventional radiologist and vice president of clinical operations and growth at Radiology Partners, believes that if practice leaders take strategic financial actions that help retain associates and non-clinical employees during the crisis, radiology will be well positioned to meet future imaging demand.
As chair of the Population Health Management Committee of ACR’s Patient- and Family-Centered Care Commission, Zaidi also sees a population health management (PHM) component to this crisis. Ensuring access to quality care to all citizens regardless of income level is a central tenant of PHM, says Zaidi, and the closure of small and rural outpatient imaging centers could hit underserved communities hard.
“Once some of these practices and centers close up, they might never come back,” Zaidi speculates. “The care would shift to hospitals, which could be located far from a given community. In that scenario, uninsured patients and those with high deductibles would have more out-of-pocket costs to bear since, on average, imaging costs are higher in hospital settings than in outpatient imaging clinics. It would become more challenging for patients to obtain appropriate preventive care and basic follow-up, likely resulting in patients presenting with more advanced states of disease.”
Breast and lung cancer will become particular challenges, according to Zaidi. “The closure of outpatient access centers combined with the current inability to screen for breast cancer and lung cancer during the crisis will cause more advanced presentations of breast and lung cancer patients in coming years,” Zaidi believes, along with other pathologies for which patients have held off accessing care until symptoms were more advanced. “This scenario will cause a further strain on an already distressed system, with community effects of the increased morbidity and mortality.”
In addition to impending disruptions to patient-centered care, Zaidi has his eye on another potential issue that, without government intervention, won’t go away once the pandemic subsides: a reallocation
of payments for evaluation and management (E/M) services. In the 2020 Medicare Physician Fee Schedule Final
Rule, CMS finalized significant changes to E/M services that will result in a major redistribution of payments from specialties to primary care physicians.
CMS has estimated the impact (including both professional and technical components) to amount to an 8% pay cut to radiology, while some analysts puts the number closer to 9%. Although the ACR is working to minimize the impact of this new policy, radiologists who do not typically bill for E/M services will likely see their payments reduced in 2021. “This impending change isn’t on a lot of radiologists’ radars right now, but an E/M reallocation would worsen an already suboptimal situation,” says Zaidi.
Rewarding certain physicians for direct patient encounters — interactions that are challenging for many specialists to enact — will only make things harder for radiologists, Zaidi believes. “To fix this, radiologists should ally with other specialists in advocating for the value of specialty care. All of healthcare should be recognized for the value we bring to the table, rather than trying to slice the healthcare dollar selectively.” On the positive side, both RADPAC and ACR are engaged in advocacy efforts to dampen the effects of E/M billing changes, having allied with other specialty societies to counter the reimbursement cuts.
While the financial picture plays out, Zaidi encourages radiologists to use this time to plan for the future. “Radiology leaders should work with their health systems to plan patient engagement efforts for when outpatient access opens up again.” Zaidi advises radiology leaders to work toward building a PHM infrastructure with patient navigator staff to prepare for care coordination efforts. “Plan for ways to work with community leaders to teach patients about, for instance, the importance of preventing lung and breast cancer. We are in the middle of a worldwide pandemic, and the safety of our loved ones is paramount. Nonetheless,” concludes Zaidi, “the time for planning ahead to ensure patients get the care they need in the near future is now.”
For a full list of COVID-19 resources for radiologists, visit ACR’s COVID-19 page.
Chris Hobson, Imaging 3.0 Senior Communications Manager