ACR Success Tied to World-Class Research and Advocacy

The following post was contributed by Ruth Carlos, MD, FACR, co-chair of the Clinical Research Pathway of ACR 2016 — The Crossroads of Radiology®.

Carlos_RuthOver the years, radiologists have learned the importance of synergy between world-class research and political advocacy to gain acceptance for their life-saving contributions to medicine. Neither one alone assures success in the courts of clinical, political or public opinion.

The American College of Radiology (ACR) continues its commitment to imaging science.  It has relied on a solid base of clinical literature for the assessments that underlie its highly respected ACR Appropriateness Criteria®. Through the ACR Imaging Network (ACRIN), the College has sponsored influential imaging-related registries and clinical trials including the National Oncologic PET Registry (NOPR), National Lung Cancer Screening Trial (NLCS) and National CT Colonography Trial (NCCT).

This tradition continues with ACRIN’s current involvement the Imaging Dementia — Evidence for Amyloid Scanning (IDEAS) study, an experiment  that will involve more than 18,000 Medicare beneficiaries to determine if brain amyloid PET helps improve outcomes for Alzheimer’s disease patients.

But effective advocacy is also needed to affect public policies governing the acceptance of such new and expensive imaging technologies. As ACR members will learn at a session entitled “From Evidence to Reimbursementat ACR 2016 — The Crossroads of Radiology®, the definitive results of NLCS were just a starting point toward the ultimate decision by Centers for Medicare & Medicaid Services (CMS) to grant a National Coverage Determination for the low-dose CT screening procedure.  It came after careful and sometimes contentious maneuvering that led to threatened Congressional action.  (See more ACR 2016 clinical research sessions.)

The ACR faces a similar situation today with CMS resistance against granting Medicare reimbursement for CT colonography (CTC), a non-invasive screening procedure shown by NCCT to be diagnostically equivalent to invasive colonoscopy. Political advocacy has again proven to be essential, and it is taking the form of an ACR Call to Action that asks ACR members to contact their senators and representatives to co-sponsor the CTC Screening for Colorectal Cancer Act of 2016 (HR 4632/SB 2262).

Coverage decisions are multifactorial. They rely not just on the underlying science but also on soft skills, such as advocacy on part of the physicians and patients who wants to see good science translated into practice.

Take Action: Impact CRC Screening Access (and Kick Cancer in the Butt)

The following post was contributed by William T. Thorwarth Jr., MD, ACR chief executive officer.

Dr Thorwarth_20140414_008ACR members are passionate about bringing value to patients and health care. The members of the ACR Colon Cancer Committee exemplify this passion in advocating for Medicare coverage of CT colonography (CTC) for colorectal cancer (CRC) screening.

CTC is endorsed by the American Cancer Society as a recommended screening test. The Blue Cross Blue Shield Association Technology Evaluation Center (TEC) named CTC an effective screening tool. Studies in Europe and at national military medical centers show CTC availability increases CRC screening rates. Studies in NEJM and Radiology prove the exam comparably accurate to optical colonoscopy. Even President Obama trusted screening CTC.

However, while CTC is covered by many private payers and Tricare, Medicare has yet to cover CTC. Medicare coverage would remove a financial barrier to this lifesaving exam that is less expensive than optical colonoscopy.

This month (National Colorectal Cancer Awareness Month), we moved closer to achieving Medicare CTC coverage. And now we need your help.

We aligned with the National Medical Association, Colon Cancer Alliance, Prevent Cancer Foundation and Colon Cancer Coalition to call on Congress to pass the CT Colonography Screening for Colorectal Cancer Act (S 2262/HR 4632).

Click here to ask your senators and representatives to support this bill (easy automated process).

You can also help increase awareness of CT colonography. Below are ACR resources to help you. Please post links to the patient materials on your websites and make patients aware of them through your social media and email communications. Also, feel free to download appropriate materials to use in your waiting rooms.

Resources for Physicians to Use to Reach Patients

Physician Resources

How to Succeed at Demonstrating Value for Reimbursement

The following post was contributed by Max Wintermark, MD, clinical adviser of Radiology Support, Communication and Alignment Network (R-SCAN)

EmWinterark_Maxerging health care models are changing the way we make patient care decisions. Whether we practice in a large academic medical center or small rural practices, we must focus on the triple aim of health care reform: simultaneously achieving higher patient satisfaction and care quality, better health outcomes and reduced costs.

 How do we, as radiologists, manage—and succeed—in this cultural shift where reimbursement will be tied directly tied to providing concrete data that demonstrate our role in the delivery of better patient care at lower costs? With the Radiology Support, Communication and Alignment Network (R-SCAN)—a program that creates a collaborative care team of radiologists and referring clinicians to improve imaging utilization, ensuring your patients are at the center of care.

Participating in the free R-SCAN initiative

  • Allows us to collect data that demonstrate radiology’s role in the delivery of better patient care to hospital administrators, payers and accountable care organizations
  • Integrates participation of radiologists, primary care physicians, emergency care physicians and other clinicians who order imaging exams in the continuum of care in outpatient and emergent care settings
  • Focuses on 11 Choosing Wisely® topics — many endorsed by multiple medical societies, having strong potential to achieve improvement in exam ordering
  • Guides us through a clinical improvement activity in three phases typically over a three- to six-month period
  • Provides free access a customized version of the ACR Select™ clinical decision support tool
  • Yields MOC Part 4 and free CME education

Need an example of an R-SCAN project? My colleagues and myself at Stanford are working with our family medicine colleagues to focus on appropriate imaging for low back pain. We gathered baseline data about prescribing patterns using R-SCAN’s dashboard and then designed an appropriate educational program using R-SCAN’s library of suggested options and educational resources. We posted Choosing Wisely-inspired flyers in clinics to explain that imaging does not always help with low back pain and that a scan is not usually recommended as a first step. Now in the post-education stage of the project, we are evaluating prescribing patterns to compare them to baseline data using the R-SCAN dashboard.

R-SCAN is a win-win-win program: Clinicians benefit from an efficient and appropriate image ordering process; radiologists demonstrate value; and patients will get better health outcomes, ideally with less cost.

Want to succeed at demonstrating value for reimbursement? It’s time to participate in R-SCAN. If you’ve registered, what type of initiative are you working on? We can learn from others’ projects.

 Want to learn more? Visit the R-SCAN website. In addition, ACR 2016 — The Crossroads of Radiology® offers the session:  Getting Ready for Value-Based Radiology (R-SCAN).