Certification in Radiology

ACR-18

This post was contributed by Howard B. Fleishon, MD, MMM, FACR, vice chair, American College of Radiology (ACR) Board of Chancellors.

The American College of Radiology (ACR) Task Force on Certification in Radiology has been busy since it was created in January 2019.

I want to thank Eric Friedberg, MD, for founding and previously leading this task force – along with his duties as Vice Chair of the ACR Commission on General, Small, Emergency and/or Rural Practice (GSER).

As this task force is intended to function across ACR commissions and committees, and in recognition of the importance of Dr. Friedberg’s work on the GSER, leadership of this task force has recently been transferred to the ACR Board of Chancellors vice chair.

As an update – under Dr. Friedberg’s leadership, four subcommittees have been developed to:

  • Research the history of certification in medicine and radiology
  • Examine best practices for credentialing and future trends in medical specialties and other industries
  • Develop and implement focus groups and general surveys to get feedback from the membership
  • Organize information and references

At RSNA 2019, this ACR task force will meet with representatives from the American Board of Radiology (ABR), American Board of Medical Specialties (ABMS) and others.

The next planned immediate task force deliverable is a report to the ACR Board of Chancellors and ACR Council in May. We also anticipate development of a more comprehensive white paper on certification in radiology.

This is an important member-driven initiative.

We will continue to keep you informed.

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How We Achieved Universal 3D Mammography Coverage in Hawaii — and How You Can, Too

GrosskreutzScott Grosskreutz, MD, diagnostic radiologist and president, Hawaii Radiological Society, contributed this post.

Hawaii’s small size and geographic isolation are part of the state’s charm, but these factors can contribute to slower adoption of newer technology such as digital breast tomosynthesis (DBT). In 2018, less than half of women in Hawaii were covered for DBT —the lowest rate of all 50 states. Our radiologists want to be able to provide the most accurate examination for all our patients, and DBT has been shown to improve breast cancer detection and decrease recall rates.

The Hawaii Radiological Society (HRS) introduced a bill into the state legislature last session, which would have mandated insurance coverage of tomosynthesis. Dr. Kelly Biggs, chair of the American College of Radiology® (ACR®) Breast Imaging Commission’s Government Relations subcommittee, provided supporting material, and Dr. Dana Smetherman, chair of the ACR Breast Imaging Commission, published a commentary with HRS president Dr. Elizabeth Ignacio in Hawaii’s largest newspaper advocating tomosynthesis.

With testimony from dozens of radiologists, patients and referring providers, the bill sailed through the House and Senate chambers on the first three readings without a single no vote, but was effectively tabled when the Conference Committee declined to convene. HRS

We immediately met with legislators who agreed to reintroduce the bill during the next session and reached out to medical directors of third party payers in Hawaii. Together, we established insurance coverage and convinced the state workers’ trust fund board to provide full DBT coverage – meaning that women in Hawaii will soon have 100% coverage for DBT. This universal coverage relieves mammography staff from the fiscal necessity of requesting copays from uninsured patients, enabling them to focus on patient care and productivity.

From our experience we offer the following suggestions:

1) Achieving coverage for DBT is a team effort. The ACR provides great resources and support, including access to experts who can help you develop your strategy for achieving coverage.

2) Share your local DBT experience. Straub Hospital in Honolulu provided a study of two-dimensional (2D) vs three-dimensional (3D) mammography. They found that DBT had almost double the cancer detection rate compared with 2D. What’s more, a large percent of women in Hawaii are of Asian ancestry, who tend to have the densest breast tissue of any ethnic group. It’s important that this demographic-specific information about the benefits of DBT in assessing women with dense breast was shared through our advocacy efforts.

3) If at first you don’t succeed, don’t give up! By immediately arranging sponsors for the bill’s reintroduction, we ensured public attention remained on the issue.

4) The medical directors working for insurance companies are our physician colleagues and share our concern for our patients. Their organizations focus on cost effectiveness and cost containment. We need to respect their concerns and be responsive to their questions. Developing a good working relationship ensures that your advocacy effort will have a fair hearing when future issues arise.

Nationally, 93% of women ages 40 to 74 have coverage for DBT, according to Truven Health Analytics. It’s time to make DBT 100% covered for all women in the US.

DBTcoveragemap_VOR

Coverage for tomosynthesis by state in 2018

 

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How Your ACR Board and Council Steering Committee Serve You

McGinty Hi RezGeraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors, contributed this post.

Your American College of Radiology® (ACR®) Board of Chancellors and Council Steering Committee (CSC), as well as key ACR staff, convened last week to focus on the future of our profession. 700 pages of pre-reading ensured that participants came prepared to share their unique perspectives and experience.

Over four days, the group reviewed detailed financial statements and heard presentations on multiple important topics. Topics of discussion ranged from the impact of proposed changes to reimbursement for Evaluation and Management services that, in a budget neutral Medicare payment system, will result in a significant reduction in reimbursement for radiology and radiation oncology services, to the work that the Commission on Publications and Lifelong Learning is doing to enable evidence-based educational efforts across all the ACR’s work.

We engaged in a scenario planning exercise to prepare for a planned refresh of the ACR’s Strategic Plan in 2020. Scenario planning seeks to help organizations avoid “optimism bias” and become more adaptable in the face of an uncertain future. Potential threats and opportunities identified include innovations in drug and liquid biopsy development that might fundamentally impact the demand for imaging, and integrated diagnostics. The need for ACR to amplify its influence with stakeholders beyond those most familiar to us – like the Centers for Medicare and Medicaid Services and Congress – was also apparent. Importantly, scenario planning is not about trying to predict the future but rather to facilitate strategy that allows organizations to be successful whatever happens.

Time spent together in person for face to face interaction and relationship building is critically important to build trust so that we can undertake difficult decisions together as stewards of our organization. The conversations allow us to understand the diversity of our perspectives and practices.

The interactions between the Board and the CSC reinforce the power of our representative governance structure and enable more effective policy making. Dr. Traci Pritchard, attending her first leadership retreat as a member of the CSC, reflected that she felt proud to be part of a committed group of volunteer leaders that is dedicated to serving the membership and the profession. I could not agree more.

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