ACR Leaders Focus on Moving Radiology Forward

CHICAGO - Declining reimbursements, commoditization, and preparing radiologists to adapt to health care reform are some of the key issues leaders from the American College of Radiology (ACR) are grappling with, according to ACR leaders who spoke at the Radiological Society of North America’s “Critical Issues Facing the Practice of Radiology” round table discussion.

Bibb Allen Jr., MD, chair of the ACR board of directors, noted that many radiologists are practicing hyper-efficient radiology in which they sit at a work station and try to minimize interruptions from referring physicians and patients, a phenomenon documented in literature. But Allen noted that the model isn’t sustainable and contributes to commoditization.

“If all we have to offer is interpretation, anybody can do it,” he said. “It can be traded on the market based on price.”

To help radiologists stay relevant, ACR has launched the Imaging 3.0 initiative. Allen said the initiative aims to help drive culture change in the specialty by providing radiologists and referring physicians with tools that will help them integrate high-value care into their workflows. The initiative, he said, also aims to better align pay incentives, so that physicians are rewarded for making these changes.

He noted that the organization has created a clinical decision support tool called ACR Select) that makes it easier for referring physicians to integrate the ACR Appropriateness Criteria into their image ordering. The program has a web-based version and can be integrated into an electronic medical record system. Bibb noted that the Appropriateness Criteria have long been widely available in books, guidelines clearing houses, and other formats, but referring physicians haven’t used them. Electronic decision support tools integrate the criteria into the imaging order workflow of an electronic record and automatically set up a radiologist consult if a physician orders a low value test.

The college is also working on developing electronic tools that will help improve radiologists’ performance. For example, the organization is working to help develop programs that will ensure fail-safe reporting of critical patient results. Bibb noted that electronic systems can ensure that critical results are reported in minutes, hours, or days depending on the urgency.

The organization is also developing decision aids for radiologists to help them make more consistent and evidence-based decisions about the tests they order.

“Our goal is to deliver all the imaging care that is beneficial and necessary and none that is not,” said Geraldine B. McGinty, MD, MBA, chair of the ACR Commission on Economics.[[{"type":"media","view_mode":"media_crop","fid":"30615","attributes":{"alt":"ACR","class":"media-image media-image-right","id":"media_crop_1763377234780","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3214","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 104px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

James A. Brink, MD, vice chair of the ACR board, said the ACR is developing dashboards to help radiologists track quality measures. These dashboards, he noted, can help practices demonstrate their value and meet the requirements of accrediting organizations.

While the ACR works to help adapt to health care reform, the organization is continuing to shore up the current fee-for-service reimbursement system most practices operate under, McGinty said.

“We are fighting hard to prevent further cuts,” she said.

She noted that the ACR has had success working with diverse stakeholders to address reimbursement issues. For example, ACR worked with patient groups, physician organizations, and others to support Medicare payments for lung cancer screening of long-time smokers and the Centers for Medicare and Medicaid Services agreed to coverage beginning in 2015.

All of these initiatives create greater opportunities for radiologists and other physicians to track the value of the care they provide. Brink said it is essential to embrace these quality improvement tools going forward. He noted that at Massachusetts General Hospital, where he is radiologist-in-chief, physicians have been able to identify areas where they may not be performing as well as their peers and improve the care they provide while reducing unnecessary imaging.

“If we don’t become our own watchdogs, others will do it for us,” Brink said.