APC Imaging: An Opportunity for Better Interaction with Ordering Clinicians?

The following post was contributed by Melissa Chen, MD

Danny R. Hughes, PhD, research director and senior research fellow of the Neiman Health Policy Institute, recently guest moderated the February ACR Resident and Fellow Journal Club session and discussed his article published in JAMA Internal Medicine titled, “A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office Based Evaluation and Management Visits.”

Advanced Practice Clinicians (APCs) often referred to as “physician extenders” include Nurse Practitioners and Physician Assistants. The article discussion took a pro-con framework, based on the question, “Are the expanding roles of APCs beneficial to radiology?”

On the con side, it was discussed that increased imaging volume by APCs in a primary care setting could dilute the value of imaging, particularly with inappropriate imaging. Additionally, it was discussed that APCs in the IR setting could potentially take away from the training of residents and fellows as they may be performing the procedures independently.

Fellow Stuart Cohen, started the discussion of the pros. He suggested that the increasing number of APCs in the clinic setting was an opportunity for radiologists to demonstrate their value by protocolling the appropriate exam with the help of ACR appropriateness criteria and functioning as the consultant in the care of the patient. In particular, Clinical Decision Support could be the key tool enabling radiologists to deliver cost-effective and quality imaging care to the patient. He argued that APCs may be a great face for radiology with proper supervision.

Joining via Twitter, resident Amy Patel and fellow Sumir Patel suggested that educating APCs about radiology appropriateness criteria prior to their clinical practice will lay the groundwork for better imaging utilization. Furthermore, radiologists need to take the lead, to make themselves more available, and educate APCs, with the help of Clinical Decision Support, to break the bad habits APCs may have picked up from physicians.

To further support the pro side of the debate, resident McKinley Glover pointed out that the increased imaging utilization could lead to overall decreased downstream health care costs, a potential area for further investigation. He also played devil’s advocate suggesting that perhaps primary care clinicians are under-ordering imaging studies, and APCs may be appropriately ordering a larger number of imaging studies.

Dr. McGinty concluded that Dr. Hughes’ work and article highlight the importance that radiologists collaborate with the health care team, and the key role Clinical Decision Support can play in preserving the value of radiology and radiologists.

The ACR Resident and Fellow Journal Club occurs bi-monthly, and we hope to continue debate of future topics that affect radiology and radiation oncology.

Information about future journal clubs can be found here.

Discussions can also be followed on twitter via @ACRRFS and #RadRes.

Radiation Oncology Sessions at The Crossroads – ACR 2015™: More than Ever Before

The following post was contributed by Seth Rosenthal, MD, FACR.

Radiation oncologists, like other American College of Radiology (ACR) members, have a stake in what comes next. New health care delivery and payment models hold changes for us and other radiology professionals. Let’s move forward together.

ACR 2015™, the College’s all-new annual meeting is much larger and more inclusive than ever before. No longer solely a governance or business meeting, it is open to all radiation oncology and radiology professionals, and boasts a far more extensive program, a new venue and a comprehensive approach.

Radiation Oncology has traditionally been well represented at the spring ACR Meeting – with the CARROS Caucus and a Saturday afternoon CME course. This year, however, there will be three full days of programming specifically for the radiation oncology community—including opportunities for CME and SA-CME credit. We also have access to Radiology Leadership Institute® (RLI) sessions and a host of economic and advocacy programming to help prepare us for medicine’s road ahead.

Like other radiation oncologists, I have traditionally gotten many educational credits elsewhere. However, the radiation oncology sessions at ACR 2015, prepared by ROs for ROs, are not the same as you might get elsewhere and are really good.

Dr. William “Bill” Small, Jr., has put together a superb program targeted at contemporary issues in radiation oncology. Given the push to get CME and SA-CME credits in the MOC era, this is a meeting that RO community members should put on their calendar.

The ACR 2015 offerings include:

The Steven Leibel Memorial Lecture: Therapeutic Gain from Technologic Advances in Radiation Oncology
Bruce Haffty, MD, FACR will deliver the lecture, introduced by Dr. Richard Hoppe, FACR

Radiotherapy Research: Building on the Past and Looking to the Future
Speakers: Seth Rosenthal, MD, FACR; William Small, MD, FACR; Christopher Crane, MD; Simon Lo, MB, ChB, FACR – introduced by Mitchell Machtay, MD

An Inside Look at Developing ACR Appropriateness Criteria® for Radiation Oncology
Speakers: Benjamin Movsas, MD, FACR; Sue Yom, MD, PhD; and William Small, MD, FACR

ACR Practice Parameters and Standards in Radiation Oncology: Evolution of Quality Within an Environment of Safety
Speakers: Seth Rosenthal, MD, FACR; Alan Hartford, MD, PhD, FACR; and Patrick Conway, MD, FACR

On top of the RO sessions to help us be better physicians, RLI sessions also teach us how to be better leaders, improve our business skills, and how to give ourselves a chance to shape the forces that affect our practices. These skills will be particularly important as we transition from volume to value-based care.

ACR 2015 is also a great excuse to visit Washington, DC in the spring. I hope to see you there!

Medicare Lung Cancer Screening Coverage: A Monumental Lift

The following post was contributed by ACR Chief Executive Officer William T. Thorwarth, MD, FACR

Securing Medicare coverage for low-dose CT lung cancer screening was a monumental lift and a tremendous victory for patients, allied providers and the American College of Radiology (ACR).

The College helped form and mobilize a coalition of dozens of medical and patient advocacy groups to educate the Centers for Medicare & Medicaid Services (CMS) that these cost-effective exams can save more lives than any cancer screening test in history – if Medicare would just cover them for high-risk beneficiaries.

ACR government relations staff and volunteers also engaged and motivated 45 bipartisan members of the U.S. Senate and 133 bipartisan members of the U.S. House of Representatives to cosign letters to CMS supporting Medicare coverage of this life saving exam.

An ACR public affairs campaign helped place our lung cancer screening position and/or spokespeople in 750 print and online news reports with cumulative readerships of nearly 800 million people. This included items in the Wall Street Journal, US News & World Report and Consumer Reports. Millions more heard these messages by radio and TV.

At the same time, the ACR mobilized experts within the College to create resources to help radiologists and allied providers to establish lung cancer screening programs in their communities:

Meanwhile, the ACR Lung Cancer Screening Registry has applied for CMS approval to help providers meet registry reporting requirements to receive Medicare reimbursement.

The College is also offering a number of lung cancer screening sessions at ACR 2015™, the college’s first ever all member meeting, May 17-25 in Washington, DC. These courses include:

I invite you to take advantage of everything ACR has to offer to help you and your patients strike back against this terrible disease that, until now, has been nearly untouchable.

All of radiology should feel good about Medicare and private insurance coverage of CT lung cancer screening and the thoughtful process that began with the American College of Radiology Imaging Network (ACRIN) National Lung Screening Trial (NLST).

As you move forward with establishing quality screening programs, stop to appreciate the tens of thousands of lives each year that we are going to help save from the nation’s leading cancer killer.