The economic policy side of radiology is never an easy read. Understanding how reimbursement will shift moving into the future is vital to practice success and quality patient care. Gregory N. Nicola, MD, FACR, Chair of the American College of Radiology® (ACR®) Commission on Economics, moderated the popular Economics Forum at ACR 2023, during which an expert panel of speakers fielded questions about the changing landscape of healthcare policy and its impact on the radiology specialty.
Panelists included Michael S. Booker, MD, MBA, Melissa M. Chen, MD, Sammy Chu, MD, FACR, Richard E. Heller III, MD, MBA, FACR, Andrew K. Moriarity, MD, Lauren P. Nicola, MD, FACR, Kurt A. Schoppe, MD, and Dana H. Smetherman, MD, MPH, MBA, FACR.
The forum opened with the presentation of the William T. Thorwarth Jr., MD, Award, established in 2004 by the ACR Commission on Economics. Zeke Silva III, MD, FACR, FSIR, FRBMA, RCC, was honored with the award for excellence in economics and health policy by exhibiting leadership, diplomacy and integrity while representing the College during many years.
The discussion began with a focus on current economic policy issues, including changes to the Medicare Physician Fee Schedule (MPFS), Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) activities, challenges with Current Procedural Terminology (CPT®) codes and the work of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), and lessons learned from the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs).
Panelists also spoke about the No Surprises Act implementation lawsuits, indirect practice expenses, non-physician radiology providers (NPRPs) and leveraging artificial intelligence (AI) for reimbursement.
Dr. Schoppe explained several issues surrounding the use of NPRPs. “There is a fear of losing education opportunities and ultimately physician jobs by radiology trainees. There is concern about physician autonomy and supervision if the physician is not employing an NPRP but is being forced into supervising them by a hospital or corporate entity. Then there is scope creep, or the expanding practice of physician assistants, nurse practitioners or radiology assistants — creating a new turf war in radiology.”
Related to AI, Dr. Chen talked about how reimbursement ties in to the MPFS. “Within the MPFS, there are ways in which new technology and new services are provided. You can have Category 3 CPT codes, for instance, which are not valued under the RUC process, but are defined by the AMA CPT editorial panel. Reimbursement isn’t guaranteed with a Category 3 code, but it allows for tracking a procedure that may be new and emerging.”
Dr. Greg Nicola concluded the panel discussion with an appreciative and reassuring message to attendees. “I hope we accomplished our goals of addressing the stresses on radiology, the regulatory market, the disruptors and how we are paid.”
For more information about the Economic Forum and topics discussed, contact Angela Kim, ACR Senior Director, Economic Policy.