From the Chair of the Board of Chancellors
Jacqueline A. Bello, MD, FACR
As we near the end of a revolutionary year for technology and health equity, I am both impressed and proud of what the College has achieved throughout 2023 to strengthen and advance the specialty for members and patients. Innovative research, fierce advocacy and a commitment to quality and safety continue to reinforce the ACR’s unique role in radiology — leading by example with state and federal policy wins and collaborative initiatives that exemplify our far-reaching contributions to science and medicine.
Our new brand was unveiled at this year’s centennial celebration at ACR 2023 in May, sporting a fresh look and a unique logo that is better aligned with today’s radiology landscape. Our new brand is a bold statement that the College is here to stay — to fight for member and patient rights like no other organization can. Being a standout, however, comes with a lot of hard work.
We Are Advocates
We have been busy on the regulatory front and are gaining traction in multiple areas. ACR-led advocacy activities supported by a coalition of provider and non-provider organizations resulted in an additional 2.5% to the Medicare Physician Fee Schedule Conversion Factor for calendar year 2023, and an additional 1.25% for 2024. For the past three years, the ACR and stakeholders have fought reimbursement cuts related to budget neutrality requirements, and the College continues to work with Congress to build a permanent payment system that provides fair provider reimbursement and guarantees Medicare beneficiaries access to quality care. As 2024 comes to a close, the ACR is working with lawmakers to address the 3.4% cut to the 2024 conversion factor, as finalized in the Calendar Year 2024 Medicare Physician Fee Schedule Final Rule.
Several legal challenges to implementation of the No Surprises Act (NSA) have resulted in favorable outcomes for the medical community. The College and others joined multiple lawsuits by the Texas Medical Association as a friend of the court against the federal government. The court found that the independent dispute resolution (IDR) administrative fee increase and batching rules violated federal law and that the government was incorrectly permitting insurers to use a faulty methodology when calculating their median in-network rate, also known as the qualifying payment amount (QPA). This has overturned several regulatory provisions and led to additional legal challenges — with the federal government appealing.
While new regulations have been proposed addressing IDR fees, batching and the overall operation of the IDR process, we await final rules and additional court decisions. The ACR will continue to engage the federal agencies implementing the NSA to ensure that patients are held harmless from surprise medical bills and the law is not slanted toward insurance companies.
The College has also shown real leadership in advancing the diagnosis and treatment of Alzheimer’s disease and has spearheaded research and advocacy efforts supported by partners including the Alzheimer’s Association.
The ACR’s government relations staff is developing strategies to help state radiological societies fight dangerous non-physician providers scope of practice (SOP) expansion legislation. As the healthcare landscape becomes more complex, we need coordinated, quality-focused and patient-centered healthcare teams serving patients. Only physicians have the necessary educational and professional experience required to lead these teams. The College has partnered with the AMA to co-brand a set of advocacy-related SOP tools.
The College has also shown real leadership in advancing the diagnosis and treatment of Alzheimer’s disease and has spearheaded research and advocacy efforts supported by partners including the Alzheimer’s Association. In large part because of these efforts, CMS published a decision memo stating it would allow Medicare coverage determinations for amyloid PET scans to be made by Medicare Administrative Contractors (MACs). In addition, CMS announced that it will no longer require coverage with evidence development for beta-amyloid PET and will allow MACs to determine coverage for these exams. This final decision means Medicare beneficiaries can potentially benefit from multiple scans over a Medicare patient’s life to monitor the extent of amyloid plaque deposits and to track the side effects of newly approved Alzheimer’s treatments. This is a significant success based on foundational research by the ACR Center for Research and Innovation™.
The ACR is actively involved in the evolution of the federal government’s regulatory policies and intentions in the realm of AI. The College filed comments this fall in response to a white paper by U.S. Sen. Bill Cassidy (R-LA) regarding federal oversight of healthcare AI. To assist radiology groups looking to put AI applications to use now, the ACR’s Data Science Institute® (DSI) unveiled AI Central. The site provides easily accessible and detailed information on FDA-cleared AI medical products related to radiology and other imaging domains. DSI staff continually review data from FDA documents, vendor information and physician user feedback to assist with appropriate AI purchasing decisions.
With the Protecting Access to Medicare Act of 2014 (PAMA), Congress established the consultation of appropriate use criteria (AUC) by providers ordering advanced diagnostic imaging exams. The AUC program is an effective, evidence-based initiative founded on physician-developed guidelines to help providers navigate through ordering decisions for appropriate advanced imaging studies. Unfortunately, statutory requirements in PAMA have resulted in numerous implementation problems and delays. The College continues to support retaining the basic structure and intent of the PAMA AUC program. While the ACR continues to work with Congress to determine legislative revisions to the current AUC program, the ACR is strongly urging its members who have already implemented clinical decision support programs to continue to use them.
We Are Research and Education
The ACR’s CRI team earlier this year celebrated the launch of its new research management system after nearly six years of planning. This will be a quantum improvement to the existing research infrastructure. The new system provides CRI and the College with not only more extensive research options but also improved interactions with a wide and diverse spectrum of collaborative research sites. This is yet another example of the ACR leading medicine as we enter a new age of data-driven healthcare.
On the medical student front, the College’s Medical Student Section has significantly increased medical students’ interest in radiology, ensuring that they get exposure to radiology early on in their medical school careers. The popular Pipeline Initiative for the Enrichment of Radiology (PIER) program — aimed at recruiting diverse candidates into the profession — continues to impress and had a 60% success match rate for interns going into radiology.
Tomosynthesis Mammographic Imaging Screening Trial (TMIST) enrollment has soared past 80,000. TMIST is the first randomized controlled trial to identify women in which digital breast tomosynthesis (DBT) may outperform (2D) digital mammography in reducing advanced breast cancer. There are 124 active sites continuing to enroll women at a pace nearly unheard of in the COVID-19 era. TMIST sites are assembling one of the most diverse cancer screening trial populations. Participation stands at 21% for Black enrollees — more than double the participation rate for that demographic in National Cancer Institute-funded clinical trials (9%).
Our BOC has also been working diligently on workforce issues and how the College can play a role in addressing shortages while maintaining quality care and evaluating drivers and solutions. The latest ACR/RSNA Workforce Survey yielded a plethora of findings — from practice ownership to diversity to subspecialty needs and employment trends. Workforce survey findings were published in October in the JACR®.
We Are Bringing People Together
This fall the College hosted the first in-person event combining Quality & Safety and Informatics. The conference in October brought together thought leaders from both groups to demonstrate the proven and potential benefits of a symbiotic approach to improving patient outcomes and advancing operational practices for safer, faster and more effective radiology practice strategies and processes. The collaborative gathering was a great opportunity to catch up in person to advance efforts around quality assurance programs, quality data management, health equity, AI tools and patient-friendly practices.
On Nov. 11, building on the huge success of last year’s event, the ACR, the American Cancer Society National Lung Cancer Roundtable, GO2 for Lung Cancer (GO2) and the Radiology Health Equity Coalition (RHEC) partnered again for the second annual National Lung Cancer Screening Day. Radiology facilities and practices across the country opened their doors on a Saturday to provide low-dose CT lung cancer screening — giving those who have job restrictions or transportation challenges during the work week a chance to get this lifesaving scan. Many patient advocates and advocate organizations participated, transforming the event into not only a day for screening but a day to share information about its importance.
In other news, the award-winning ACR Bulletin went green this summer. The transition to a digital-only publication is not only good for the planet but allows us to offer even more unique features and content our members have come to rely on. The new online format provides podcasts, timely news and in-depth looks at the important work of radiology innovators and program leaders.
On a personal note, I am saddened to see the departure next June of our CEO, William T. Thorwarth Jr., MD, FACR, but excited for whatever lies ahead for this exceptional leader. His contributions to the College number too many to list, and we can only hope our new CEO will embody the same qualities and capabilities Bill has exhibited over his many years with the College.
I am confident the New Year will bring even more victories around fair reimbursement, patient outreach, equitable access to care and evolving AI solutions. I can hardly wait to see what 2024 has in store for us all!