Moving Toward Patient-Centered Radiology

The following post was contributed by Geraldine McGinty, MD, MBA, FACR.

If you have read my latest ACR Bulletin column, you know I spoke with James V. Rawson, MD, FACR, about his role as chair of the brand new ACR Commission on Patient Experience.

I’ve worked with Jim for several years in his role as chair of our Committee on the Hospital Outpatient Prospective Payment System (HOPPS). He’s also a leader in our digital community with more than 3,000 Twitter followers (‪@Jim_Rawson_MD‬‬‬‬‪). ‬‬‬‬‬‬‬‬‬
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Jim explained the commission’‬‬s first steps, ‬‬‬‬‬‬‬‬‬‬addressed the ways in which patient experience is increasingly tied to reimbursement and told us how he responds when people say radiologists should “just stay in the reading room.“

So, check out my Q+A with Dr. Rawson and the new Patient Experience Resources section on ACR.org.

And please, share your thoughts below on how you think radiology should approach patient-centered alternative payment models.

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Imaging 3.0 Starting to Impact National Policy Discussions

The following post was contributed by Geraldine McGinty, MD, MBA, FACR.

It’s been 3 years since the ACR initiated the Imaging 3.0 initiative and the recent Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare” resonates strongly with where Imaging 3.0 has brought us as a profession.

It’s not surprising since ACR leadership engaged the IOM on this project, but it is encouraging to see an influential voice in health care like the IOM advocate so strongly for the role of the radiologist in improving the quality of care our patients receive.

As I have written previously, an ACR workgroup has been convened around the new payment models created by the MACRA legislation that replaced the flawed SGR payment update formula for Medicare.

The IOM’s recommendations will reinforce our commitment to making sure that the radiology-specific performance metrics and Alternative Payment Models that we propose to Medicare are congruent with the report’s goals – especially those around engaging our patients.

We’ve always talked about the 3 facets of Imaging 3.0: culture change, informatics infrastructure and tools, and incentive alignment.

The IOM report suggests that the often challenging culture change we have undergone, and continue to undergo, will take us in the right direction. It supports our oft-stated view that informatics must support patient care and engagement. Lastly, this IOM report will undoubtedly be a part of the ongoing conversation about how to value and pay for care.

Therefore, the fact that it is so well-aligned with our efforts to incentivize the delivery of high-value imaging care is a cause for optimism about our ability to influence the process.

Practice Leaders: Talk to Your Team About APMs

The following post was contributed by Geraldine McGinty, MD, MBA, FACR.

As part of our response to CMS on the new value-based payment models legislated in the MACRA statute, the ACR polled a broad range of members about their current experience with value based-payment models. Nearly 200 of you responded. Not surprisingly, the majority of our respondents are not yet involved in these payment models.

At most, 40 percent of the respondents reported working in alternative payment models (APMs) such as Accountable Care Organizations. Half of these radiologists are still being paid fee-for-service only. There is less involvement in other types of APMs such as capitation and to an even lesser extent sharing in any savings or risk.

For those working in the various models, most do not yet know how well the arrangement is working under their contracts. Only 2–15 percent replied that their model was working well with value-based payment models. A bonus on fee-for-service was reported to be working best for radiologists, followed by the ACO experience. The top factors considered in the assessment of APM performance were quality measures, cost savings and utilization management. Only about 20 respondents said that they will see some form of shared savings with no consistency in the percentages offered.

The majority of respondents practice in community hospitals followed by academic medical centers, freestanding imaging centers with a few practicing in independent diagnostic testing facilities. Most work in suburban and urban settings with few rural areas represented. The size of the responding groups ranged from one to 190 radiologists with approximately half in larger groups of 25 physicians or more.

If you are a practice leader, and your practice is participating in an APM, you might consider discussing that with your team (if you have not already). Also, while we got some great information from those who have dipped their toes in the shared savings water we wonder if there are other success stories or cautionary tales that could inform our work.

So, if you are a practice leader and did not respond to our survey, please caucus with your finance and management team and let us know how this transition to value-based payments is impacting you so far.

Since our survey is now closed, please email your responses to me at gmcginty@acr.org.