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

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