Many Battles on Many Fronts

youmansThis post was contributed by David C. Youmans, MD, FACR, chair of the ACR Radiology Advocacy Network.

ACR members are fighting for their patients and practices not only in Washington, but in all 50 states.

In some instances, bad legislation or regulation we counter stems from organized efforts of other groups. Sometimes, those with good intentions receive bad information or don’t consider likely ramifications of their actions. Sometimes, it is a combination of all these factors.

Case in point: Kentucky recently passed a law effectively barring radiologists from reading X-rays involved in state Black Lung Disease cases. Despite the fact that the National Institute for Occupational Safety and Health (NIOSH) sets rigorous standards to read these exams (regardless of medical specialty), and that radiologists have previously done so, the new KY law allows only pulmonologists to become “B-readers” – as those who read these scans are known.

According to media reports, the state representative who introduced the bill, had never heard of NIOSH. Neither he, nor any other state representative spoke with NIOSH, the ACR, nor any other medical society – including the pulmonologists – who, along with ACR, have come out against the law.

Kentucky lawmakers have pledged to address the new law in the next legislative session. The ACR will be sure they do.

But the ACR is working in state houses and state regulatory agencies nationwide – whether it is informing breast density legislation in dozens of states, scope of practice laws in Arizona, or balance billing legislation in New Hampshire, New Jersey, Oregon and Virginia.

The College also counters actions of private insurers that may restrict ready access to care – or hamper our ability to serve patients. This includes our opposition to the Anthem outpatient and emergency imaging policies.

We face many battles on many fronts. We need to support each other in these efforts. And we need more of us to get involved.

I invite you to take part in the Radiology Advocacy Network (RAN). The RAN (‎@ACRRAN) allows us to quickly and efficiently take action on behalf of patients and our practices at the state and federal levels.

Together, we are making a difference. The more of us that get involved – the more good we can do.

  • To be effective, we monitor issues in all 50 states, but our members are some of our most important resources.  What issues are you and your colleagues most concerned about? 

Please provide your thoughts the comments section below or on the Engage discussion board (login required).


Change Is a Part of Life…and Medicine


Dr. Monticciolo

The following post was contributed by Debra Monticciolo, MD, FACR, chair of the American College of Radiology (ACR) Breast Imaging Commission and Wendy B. DeMartini, MD, FSBI, president of the Society of Breast Imaging (SBI).

The latest scientific evidence (and that before) overwhelmingly supports a continued general recommendation that women start annual breast cancer screening at age 40. However, this information increasingly supports augmented and earlier screening for many women.

DeMartini Wendy

Dr. DeMartini

This is why the ACR and SBI have dramatically changed the approach of our new screening guidelines.

Particularly – new for 2018 are:

  • African-American women are now officially recognized as being at high risk for breast cancer.
  • All women should have a risk assessment (using an established risk assessment tools) by age 30.
  • Women previously diagnosed with breast cancer should be screened with MRI.

2015 National Cancer Institute SEER data show that the U.S. breast cancer death rate in women, unchanged for the previous 50 years, has dropped 43 percent since mammography became widespread in the 1980s. Breast cancer deaths in men, who have the same treatment as women but are not screened, have not declined.

However, we have seen only a 23 percent drop in African-American breast cancer deaths. We need a different approach in caring for these women and others at higher risk for the disease.

Recognizing that – we opted to change our guidelines now. The ACR and SBI are the first medical societies to make these recommendations, but as the experts in breast imaging, we have a responsibility to lead.

Change is a part of life – and medicine. Together, we can save more women from this deadly disease.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

What It’s Really Like to Participate in an ACR Fellowship

DrBookerThis post was contributed by Michael Booker, MD, MBA, who is a 3rd year radiology resident at the University of California, San Diego.

It can be daunting as a resident to try to understand the modern United States healthcare system. The industry is incredibly complex and often incomprehensible, with innumerable acronyms, acronyms within acronyms, and opaque language and terminology. Despite this, sustainable and impactful change requires that radiologists become familiar with the current system to drive future transformation. Fortunately for residents and fellows, the American College of Radiology (ACR) invests their time and expertise mentoring and teaching trainees for just this purpose.

The ACR Fellowship Programs represent a particularly unique opportunity to spend dedicated time not only learning, but also working with thought leaders at the ACR. I recently participated in the James M. Moorefield Economics & Health Policy Fellowship. The fellowship, which first began in 2003, is named for Dr. Moorefield in recognition of his service on the ACR Commission on Economics and for his help developing and implementing a relative value scale for radiology in the face of proposed payment cuts.  These efforts continue as a major component of the ACR, and greatly impact every practicing radiologist in the country.

The Moorefield Fellowship embedded me in the Economics and Health Policy teams at ACR headquarters in Virginia for two weeks. Importantly, no prior knowledge was required! The staff was warm and welcoming – eager to meet me at my level of understanding, with dedicated time for teaching and discussion. Not surprisingly, there is no shortage of activity when it comes to economics and health policy. I had the opportunity to work on projects which touched on CPT, RUC, APM/MACRA, HOPPS, clinical decision support, private payer coverage, etc. Specifically, I worked on upcoming RUC cycle relative value unit reevaluations, coding and nomenclature support for ACR members, and site-neutral payment policies. These experiences were bolstered by adjunct opportunities to be a guest of the ACR at recent CPT and RUC meetings. Since I am going into Body Imaging, I specifically involved myself on projects evaluating private insurance coverage for MRI Prostate and CT Colonography reimbursement. I was also able to travel the short commute to the ACR Government Relations office in downtown Washington, DC, where I attended a MedPAC meeting pertinent to medical imaging.

To make the most of being physically present at ACR headquarters, the fellowship also provided opportunities to meet with departments throughout the organization, including the Data Science Institute, Quality and Safety, ACR Press, Harvey L. Neiman Health Policy Institute, Legal, and Membership. The breadth and depth of work being done on behalf of ACR members and our patients is truly astounding, and correlates with an equally large number of opportunities for engagement depending on your interests and experience.

It goes without saying that the Moorefield Fellowship is an incredibly unique opportunity. The two weeks I spent at the ACR, and the ongoing relationships I formed, easily exceeded all of my expectations. I strongly encourage residents and fellows to browse the list of fellowships and apply for the one you find most interesting. The more informed and engaged radiologists and radiation oncologists become, the better the future will be for our specialty and our patients.

  • Have you participated in the Moorefield Fellowship, or one of our other fellowships? 
  • Do you know someone who might be interested in the Moorefield Fellowship? Apply by June 1, 2018.

Please share your thoughts in the comments section below and join the discussion oEngage (login required).