2013: Fighting The Good Fight

Last week, legislators in Washington conducted their final business of 2013. As the House Ways and Means and the Senate Finance Committees sent their SGR repeal versions to markup, the Clinical Decision Support provisions, so important for radiology, stood up against several challenges by stakeholders including CMS.

The legislation as proposed is not perfect. However, the significance of this milestone cannot be overstated. Health care is in a generational paradigm shift. The nation is transitioning from prioritizing value rather than volume. Unfortunately, providers are stuck in a financial chasm as reimbursement plans lag behind the regulatory reforms, sometimes referred to as “death valley”. But clearly this is where radiology is headed. And we are being proactive. Payment reform is the vital key to the transformation of radiology and Imaging 3.0.

As we reflect upon this moment, we should acknowledge the years of hard work, planning, investment and commitment by the ACR and staff. Government relations work can be agonizingly frustrating. But it is a requisite for all of our practices to be successful.

The work is not complete. As we move into the new year and look past the short-term doc fix, the SGR debate will move to deciding “pay fors” and issues such as annual updates.

But for right now, for radiology, it is a great way to end the year.

Geraldine and I want to wish you and your families a wonderful holiday season and a happy and successful new year.

2013: The Year in ACR Economics

For the ACR Economics team, 2013 was another year where we saw significant reimbursement cuts to Imaging services. That is a tough message to give our members who are struggling under the weight of accumulated reductions. That said, without our tireless Economics volunteers and staff and their efforts these reductions could have been much worse.

This year has also seen us telling the Imaging 3.0 story both within the profession as well as to the outside world.
Speaking at the AMCLC and State Chapter meetings, to lawmakers on Capitol Hill, to our patients via Social Media and to other physicians at venues like the AMA we’ve firmly established that radiologists are part of the solution to high-value care. Most importantly, we have been making the point that radiologists need relevant quality measures and incentives to mitigate the crushing reimbursement reductions so that they can continue to provide that high value care. Language currently in the SGR reform bill requires the use of Clinical Decision Support for advanced imaging for Medicare. We are optimistic that our advocacy for this policy has already changed the perception of radiologists among policy and lawmakers. We will do all we can to leverage that towards meaningful participation by radiologists in the value based healthcare economy.

I’ll end on a personal note of thanks to all of you who are ACR members and who support all of us in doing our work for the College. It is an honor to represent you.

The Ripple Effect: Colorado Clean Claims Task Force

Although we are constantly watching Washington for legislation that will affect radiology, another important source of ideas, laws and regulations that we need to monitor are the states. For example, the Medical Clean Claims, Transparency and Uniformity Task Force was formed as a result of the Colorado legislature’s passage of HB10-1332 in 2010. The task force is composed of providers, payers and government representatives. The charge is to develop a uniform set of insurance codes and payment rules for all health care provider contracts. The goal is to significantly reduce the cost of administrative redundancies through standardization, consistency, transparency and appropriate savings to the health care system.

The concept can have significant ramifications for radiology. Any accepted changes would automatically be adopted by all payers in the state. Consider the Multiple Procedure Payment Reduction scheme that was adopted by the Centers for Medicare and Medicaid Services. Those reductions would then be immediately part of any provider contract in the state. Any negotiating opportunities by individual groups would be circumvented by law.

The report of the task force is due at any time. Other states are watching the outcome closely. We will continue to keep you informed through this blog and other networking opportunities.

But the greater point is that we all need to monitor legislative activity in our state. Larger chapters have legislative committees or dedicated lobbyist. The American College of Radiology (ACR) State Government Relations Committee meets on at least a quarterly basis to provide updates to their members. The ACR also maintains close surveillance on state legislation. But we need your help in providing grassroots advocacy. For more information, contact Eugenia Krimer at ekrimer@acr.org.

Author – Howard B. Fleishon, M.D., MMM, FACR