Easing Radiology’s Transition to MIPS

Dr. SilvaThis post was contributed by Ezequiel Silva, MD, chair of the American College of Radiology Commission on Economics.

The evolving alphabet soup of health care payment and delivery change programs is heating up. And, ready or not, we all have to take a bite. The American College of Radiology (ACR) is working to  make these changes as pallet-friendly as possible and avoid any indigestion.

Just this week, the College sent comments to CMS urging improvements to the CY 2018 Quality Payment Program (QPP) proposed rule.

The ACR supported the CMS proposal to make appropriate use criteria (AUC) consultation a high weighted improvement activity under the Merit-based Incentive Payment Systems (MIPS). But the College urged CMS to enable radiologists to earn credit for supporting their referring clinicians in AUC implementation through qualified clinical decision support mechanisms.

The ACR praised CMS for raising the low volume threshold — which would exempt more clinicians and small groups from MIPS. We urged CMS to consistently apply how individual thresholds are scaled to group practices. We suggested they look to patient-facing group criteria as an example. That is, if 75 percent of eligible clinicians in a group meet the low-volume threshold, the group would not be MIPS eligible. 

We also urged CMS to extend application of the small practice bonus point system to rural practices as well. CMS would add 5 points to the MIPS final score of an eligible clinician or small practice group (15 or fewer clinicians) — if the clinician or group submits data on at least one performance category. Rural practices continue to have issues related to EHR interoperability and adoption of technology that would ease their reporting burden.

Use Free Resources

The ACR has created not only our MIPS page, but an interactive QPP microsite to help walk you through what CMS has actually done, how it may affect you and how you and your practice can prepare for what is coming.

Many other ACR tools and resources — from Be MACRA Ready: A Decision Guide for Radiologists to webinars and informational articles — can be found in the Be MACRA Ready section on the ACR website.

Read JACR Special Collection

The Journal of the American College of Radiology (JACR) offers a new special collection of MACRA-related articles, which will aid you as we shift from the volume-driven care of traditional fee-for-service to a value-driven payment system.

We want to hear from you:

  • What is your radiology practice doing to be ready for MIPS in 2018?
  • What ACR resources did you find most beneficial?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

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Does Your Scan Reflect R-SCAN?

This post was contributed by Gregory N. Nicola, MD, FACR, chair of the ACR Economics Committee on MACRA.

Nicola_GYes, this blog’s title is tongue in cheek. But the question is important.

It’s important if you’re participating in the Merit-based Incentive Payment Systems (MIPS) component of the Centers for Medicaid and Medicare Services (CMS) Quality Payment Program (QPP).

Radiologists and collaborating referring doctors may earn seven medium-weight Improvement Activity (IA) credits for completing a Radiology Support, Communication and Alignment Network (R-SCAN) project this year. With one R-SCAN project, both radiologists and referring clinicians may meet all of their IA requirements to achieve MIPS credit.

More than 150 radiology practices — from small private practices to large academic centers — and referring practices are participating in R-SCAN to meet IA requirements. You need to show activity engagement for 90 consecutive days. So, there’s time for you to get started this year.

Taking part in R-SCAN brings radiologists and referring clinicians together to improve imaging appropriateness based on Choosing Wisely topics.

It prepares you for the coming federal mandate that health care providers consult appropriate use criteria before ordering advanced imaging for Medicare patients. It gets referring doctors familiar with clinical decision support technology at no cost. R-SCAN participants gain free access to a customized version the ACR Select® CDS tool, the web-based version of the ACR Appropriateness Criteria®.

And, you and referring doctors can get complimentary CME credit.

More information can be found on the R-SCAN website, including the how-to guide, topics, general resources, topic-specific resources and FAQs.

R-SCAN shows our commitment to providing value-based care. Others can see our efforts to improve quality, reduce low-value scans and lower imaging costs, which are essential under advanced payment models. It’s time to get started with R-SCAN.

If you’re participating in R-SCAN, tell us about your project.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Is the Future of Radiology Diversity, Acceptance and Mutual Understanding?

This post was contributed by Amy Patel, MD, breast radiologist, Beth Israel Deaconess Medical Center, Boston, Mass.

Patel_AmyI consider myself the eternal optimist. I am also a realist regarding the differing opinions of the fabric of our society and how difficult these discussions can be.

However, it’s an indisputable fact that diversity is proving to be invaluable in the business world and other arenas in the United States.

  • In fact, according to a Forbes study of 321 executives in companies that grossed $500 million or more annually, one of the “key findings” was that “Diversity is a key driver of innovation and is a critical component of being successful on a global scale.”
  • McKinsey Global Institute reported that fostering women’s equality can potentially add $12 trillion to the global gross domestic product by 2025.
  • It is projected that by 2055 the United States will no longer be comprised of a majority regarding race or ethnicity.

Consequently, we as radiologists will be serving a diverse patient population. We will need to be prepared to meet the needs of our patients, including arriving to mutual understanding to better serve them.

The recent ACR Intersociety Summer Conference focused on the subject of diversity and inclusion, including devising action plans ranging from creating a pipeline to recruit female and underrepresented minority medical students into radiology to potentially implementing programs at institutions across the country that support our patients and fellow colleagues.

Remarkably, we are seeing a shift in perspectives regarding diversity in millennials as this topic was considered “the new norm” — reinforced during the meeting both by attendees and on social media. As a millennial, I feel more accustomed to welcome any patient demographic, as this is all my generation has ever really known, largely beginning from our training in medical school; Inclusion is second nature in many instances.

I acknowledge that we must not overgeneralize regarding one generation versus another, but we can certainly learn from one another if we keep the discussion going and are willing to be empathetic toward one another’s viewpoint. Additionally, we must not forget that the spectrum of diversity includes additional social constructs that we must embrace, including late-career colleagues and colleagues with disabilities.

As we look toward the future, we must provide resources to better educate radiologists at all levels of training to enrich our profession to be a successful, vibrant and, most importantly, an inclusionary one.

  • How are you preparing to meet the needs of a diverse patient population?
  • Do you think attitudes toward diversity differ based on generation? If so, how do you think it will affect radiology in the future?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).