In this interview, we talk with Gregory Nicola, MD, Vice President of the Hackensack Radiology Group in Hackensack, NJ, about the opportunities of the ACR Qualified Clinical Data Registry (QCDR) and the importance of participating in ACR data registries.

What are the benefits of using QCDR to satisfy Medicare’s reporting objectives? 
For many practices, QCDR is much more flexible than other Physician Quality Reporting System (PQRS) reporting options. For example, a large number of radiologists use their billing company and report via claims-based mechanisms. The problem with claims-based reporting is that there are not many metrics available for radiologists to report. The requirements are that you have to report on nine measures over three National Quality Strategy domains. Most radiologists have nowhere near nine, so if you use claims-based reporting, you must go through a measure applicability validation (MAV) process. And Medicare just scours all the CPT codes you billed for and determines whether any of them have claims-based measures you could have reported.

For 2016 QCDR reporting, you can now report at the group level instead of for individuals (which is how you must report via claims). Instead of reporting nine measures for each doctor, you report nine measures across the whole group. It makes the PQRS reporting program significantly easier.

What is the importance of the QCDR for the future of radiology? 
Besides being a real quality improvement activity for your practice, QCDR will also make it easier to navigate the upcoming Merit-Based Incentive Payment System (MIPS) under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), which starts in 2019. Based on how Medicare's quality programs have worked in the past, we expect that there will be a year or two “look back,” so the data CMS will use first for MIPS will likely be from 2017. So the relevance of QCDR will rear its head soon. 

How many relevant measures are available with QCDR?
With QCDR reporting, there are 65 available measures in 2016, so you can readily apply at least half of those in your practice. At the end of the year — before you submit to CMS — you already know exactly how well you've done on those measures based on your quarterly feedback reports from ACR. After the year is over, you can handpick the nine measures where you've done the best, which is a big benefit. That allows you to get a high score for reporting, which may be an advantage under the Value-Based Payment Modifier (VM) program.

That's exactly what my practice does. We’re able to collect about 25 measures for our groups; and, at the end of the year, I select the nine measures where our doctors do well and report only on those. It protects you from the MAV and gives you the best opportunity to achieve the program in its full capacity. If you hope to get the highest composite score under the current VM (and future MIPS programs), knowing your data and being able to handpick your measures is the way to succeed.

How does that contribute to the economics and success of your practice?
Number one, it helps protect income and, potentially allows you to earn a bonus on your revenue. Additionally, the feedback reports are an important component of our quality improvement program to help doctors understand and use the performance metrics. Most importantly, our hospital-based quality team is extremely impressed with our department when I show up to our quarterly meetings with spreadsheets showing where we are on all sorts of metrics in our department. No other private practice in our hospital submits quality reports to the hospital like we do. It takes a lot of pressure off the hospital. They leave us as an independent group, because they know we're doing the right things. It lets the hospital know that we’re serious about quality. 

Beyond QCDR, what is the value of participating in ACR registries? 
Participating in the ACR Dose Index Registry® (DIR) is a great example of how data registries bring significant value to our patients. With DIR, we know what other people in our community and across the country are able to achieve: low radiation dose CT that still provides good diagnostic-quality images. As a result, we may adjust our practice patterns so we’re more in line with the national benchmarks. That's a huge benefit to our patients. They come to us and sometimes get a quarter of the radiation dose they might get from somebody who's not looking at the radiation from their CT.

Here’s another example. We track turnaround times in the registry. We're a 24/7 practice, and we noticed — through the registry — that our turnaround times were creeping up on our overnight shift. With objective data in hand, we decided as a group to add people to the later shift to provide better turnaround times and better service. We can make objective hiring decisions based on data.

Finally, it's financially important to think about how radiology practices can integrate alternative payment models (APMs). But it's hard to go from 0 to 60. Reporting to registries and looking at your quality, efficiency and cost-reduction metrics — those are all things that are in line with what APMs are trying to do, so it's a stepping-stone into being a participant in an APM. It gives you the skillset necessary to succeed.

What advice do you have for radiologists about getting involved in quality and safety, about participating in registries, and knowing what's coming and being prepared for it? 
As radiologists, we cannot protect reimbursement anymore without thinking about quality. Reimbursement is a much larger umbrella than it ever was, and quality is an imperative part of that. That's exactly what health care reform is doing; you need to be aware of quality just to get paid properly. Beyond that, there is going to be a lot of transparency in our health care system. Everything you do as a practice, especially in regards to these quality metrics, will be public, so patients will be able to choose the right health care provider. As a result, we are not only protecting reimbursement (because quality is now tied to it), we’re also protecting our reputations. So quality becomes even more imperative. Beyond that, it's the right thing to do for our patients.