I spent most of last week at the AMA/Specialty Society Relative Value Scale Update Committee (RUC) meeting. For anyone not familiar with it, the RUC makes recommendations for valuation of services to Medicare. With pressure to restrain spending and a relatively fixed pool of money to spend in the Medicare Physician Fee Schedule the discussions can be robust and often challenging to those presenting. I sit on the RUC as the radiology member, but I am required to act as an expert not an advocate. We are lucky, therefore, to have a team of radiologists, known as RUC advisors, who are not only experts, but can also be passionate advocates for the value of what we as radiologists do for our patients. They present the results of surveys that you complete and argue for appropriate valuation. The American College of Radiology’s (ACR) team is led by our Economics Commission Vice Chair, Zeke Silva, M.D., and our team works closely with representatives from the American Society of Neuroradiology; Society of Interventional Radiology; Society of Nuclear Medicine and Molecular Imaging; American Roentgen Ray Society; Association of University Radiologists; Society of Breast Imaging and others to make sure that we advocate for fair reimbursement for the services you all provide.
The days at the RUC are long; 10 hour meetings are not unusual. Radiology has been the busiest specialty there in recent years. Each person representing our profession took at least 3 days away from their practice (and does this 3 times per year) to be there on our behalf. I want to thank our team, including our amazing ACR staff, for their dedication to our specialty and more importantly to our patients.
For the ACR Economics team, 2013 was another year where we saw significant reimbursement cuts to Imaging services. That is a tough message to give our members who are struggling under the weight of accumulated reductions. That said, without our tireless Economics volunteers and staff and their efforts these reductions could have been much worse.
This year has also seen us telling the Imaging 3.0 story both within the profession as well as to the outside world.
Speaking at the AMCLC and State Chapter meetings, to lawmakers on Capitol Hill, to our patients via Social Media and to other physicians at venues like the AMA we’ve firmly established that radiologists are part of the solution to high-value care. Most importantly, we have been making the point that radiologists need relevant quality measures and incentives to mitigate the crushing reimbursement reductions so that they can continue to provide that high value care. Language currently in the SGR reform bill requires the use of Clinical Decision Support for advanced imaging for Medicare. We are optimistic that our advocacy for this policy has already changed the perception of radiologists among policy and lawmakers. We will do all we can to leverage that towards meaningful participation by radiologists in the value based healthcare economy.
I’ll end on a personal note of thanks to all of you who are ACR members and who support all of us in doing our work for the College. It is an honor to represent you.
The United States Preventive Services Task Force (USPSTF) announced last Friday that it is going to review its guidelines for breast cancer screening. The process by which the utility of a screening test is determined must be transparent, free of bias and based on the best science available. Back in 2009 the USPSTF decided that women 50-74 only need a mammogram every other year and women under 40 should make an individual decision with their doctor. This, despite ample evidence that mammography saves lives and is efficacious in doing so even for younger women.
At a time when the health care system is trying to function more effectively at lower cost we have to hope that the policy makers and members of the USPSTF will focus on the science and make a decision that reflects that.
It’s 20 years since I was a breast imaging fellow with Dr. Dan Kopans at Massachusetts General Hospital. The misinformation about the value of screening started back then with the Canadian National Breast Screening Study, which was inherently deeply flawed. Alas the drumbeat of scepticism has beat steadily since. Cascading reimbursement cuts to imaging have impacted the availability of mammography services. If the new bundled breast biopsy codes are, as has typically been the case with bundled codes recently, associated with significant decreases in reimbursement, access may decline even further.
Breast cancer awareness month has passed but rest assured that your team at the American College of Radiology works to maintain access to this life saving service for our patients all year round.
Author – Geraldine B. McGinty, M.D., MBA, FACR