SGR Countdown

We are in a three month countdown to another 25 percent financial cliff for physician reimbursement if Congress does not pass legislation reforming the flawed Sustainable Growth Rate (SGR) formula. In the latest SGR reform versions being proposed, a critical piece for Radiology is the inclusion of clinical decision support (CDS) for advanced diagnostic imaging.

CDS is a vital part of the American College of Radiology’s (ACR) strategy for the future of radiology. CDS leverages the years of research and time invested by the College in developing appropriateness criteria. Most importantly, CDS underscores our integrity as doctors: doing the right exam for the right patient at the right time. CDS also serves as a physician centric, data-based replacement for the proposed Medicare pre-authorization program promoted by the president’s budget over the past several years. CDS has also dramatically changed the conversation about radiology in Congress and the Centers for Medicare and Medicaid Services by delivering an important value proposition.

SGR reform still faces an uncertain future. But with Congressional Budget Office scoring SGR legislation as low as $150 billion, there has never been a better opportunity over the past decade to pass this legislation.

Although we are encouraged by the inclusion of CDS in the current congressional SGR reform packages, we must remain wary of how Congress intends to pay for this legislation.  As such, we must continue to remain vigilant that radiology does not suffer additional, or worse yet, disproportional cuts. Stay tuned to this blog and ACR communications for updates.

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

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Potential Loss of Breast Needle Biopsy Access Due to CPT Code Changes

As many American College of Radiology (ACR) members are aware, the 2014 Current Procedural Terminology (CPT) codes include six breast biopsy codes that have resulted in decreases in relative value units (RVUs) and reimbursement for image-guided percutaneous breast core needle biopsies. The ACR estimates this will result in a 38 percent reduction in professional component and 7 percent reduction in global payment for the breast biopsy codes.

Review of information from the ACR breast ultrasound and stereotactic core needle biopsy accreditation programs provides some insight into availability of breast biopsy services. Currently, 1,982 facilities are accredited to perform breast ultrasound and 1,303 facilities are accredited to perform stereotactic core needle biopsy. The pace of initial applications has slowed (207 in 2013, 303 in 2012 and 336 in 2011 for ultrasound and 211 in 2013, 246 in 2012 and 244 in 2011 for stereotactic) while the total number of facilities seeking initial and renewal accreditation is stable (709 in 2013, 673 in 2012 and 676 in 2011 for ultrasound and 524 in 2013, 536 in 2012 and 436 in 2011 for stereotactic). This data suggests that, even before the recent reduction in reimbursement, the number of facilities performing breast biopsies was not increasing.

This decrease in reimbursement could certainly discourage practices from starting or expanding breast biopsy services. It may even prove financially difficult for some facilities to continue to perform these procedures. As the population ages, we may find that access for breast biopsies is declining just as the demand for these procedures is on the rise.

Author – Dana H. Smetherman, M.D., MPH, FACR

What’s for Dinner? One Member’s Perspective on What’s Keeping Young Physicians Up at Night

Get up. Work out. Shower. Lay kids clothes out. Lunches. Work. Basketball practice. Dance. Get dinner. Homework. Bathe the kids. Oh. And Breathe.

Sound familiar? When asked what was keeping the Young Physician Section up at night, the overwhelming response was “Seriously?” Unless my kid crawls into bed with me at 3 a.m., I’m not sure anything is keeping me up at night that has to do with radiology.” The issue is not that young physicians do not have the desire to be involved and make a difference for the future, it is more an issue of how in the world do you manage it?

It has been often said that if you don’t show up to the dinner table, you WILL become dinner. That has never been more true. With the shift of radiology from volume to value-based reimbursement, there is uncertainty of future payment models that can be very unsettling to the young physician. We have many more years to practice. Thankfully, the ACR has been proactive with concepts such as the Radiology Leadership Institute® and Imaging 3.0™ that keep us ahead of the curve, and give us the tools to not only adapt to these changes, but become proactive rather than reactive.

Yes, life is absolutely crazy. But at the end of the day, you make time for what’s important. If patient care, the future of radiology, and reimbursement are important to you, then you’ll find the time. A little bit of commitment can go a long way. For more information on being involved, contact the ACR at commissions@acr.org or 1-800-227-5463.

Author – Amy Kirby, M.D., Young Physician Section Member, Chapter President