Moore takes over reins at ACR

Once again, it's time for leadership change in the American College of Radiology.

In May, Dr. Arl Van Moore Jr., of Charlotte, NC, succeeded Dr. James Borgstede as chair of the ACR board of chancellors. Moore has been board vice chair since 2004. He also heads several ACR initiatives:

• chair of the ACR delegation to the American Medical Association

• chair of the task force on international teleradiology

• chair of the task force on disaster preparedness

• chair of RADPAC, the ACR's political action committee

• vice chair of the advisory committee on diagnostic imaging policy

As the board chair, Moore will be the main spokesperson for the ACR. He will also coordinate all activities for the board and the commissions, to ensure everyone is moving in the same direction.

Many of the issues he faces are familiar ones.

"There will continue to be reimbursement challenges, with government payers as well as private payers looking for ways to decrease their costs," Moore told Diagnostic Imaging.

The Deficit Reduction Act of 2005 is a top ACR concern. The college is currently pushing for a two-year delay in the DRA's Jan. 1, 2007, implementation. Provisions in the DRA cut Medicare reimbursement for imaging services over the course of five years by between $2 billion and $6 billion (depending on whom you ask).

Congress used the DRA to mandate capping the technical component of imaging to the lesser amount of either the Hospital Outpatient Prospective Payment System (HOPPS) or the Physician Fee Schedule. This approach troubles the ACR.

"Our biggest concern is having reimbursement determined by HOPPS or APC [ambulatory payment classification] rather than a resource-based method such as the fee schedule," Moore said.

The resource-based relative value scale, or RBRVS, has been used for nearly a decade to determine practice expenses. RBRVS was developed by the Centers for Medicare and Medicaid Services to create a national Physician Fee Schedule for Medicare. RBRVS has three components:

• physician work

• practice expense (direct and indirect)

• malpractice

Each component is adjusted to reflect different costs for different geographic areas.

Under HOPPS, Medicare pays for hospital outpatient services on a rate-per-service basis that varies according to the APC group to which the service is assigned. Each APC weight represents the median hospital cost of the services.

HOPPS and APC are not resource-based. They are more of an accounting procedure and can vary from hospital to hospital and from cost center to cost center, Moore said. The ACR has maintained for years that the APC system is flawed and needs overhauling.

"However it is determined, we believe that practice expenses need to be resource-based," he said.

Delay in the act's implementation will give radiologists, government officials, and other stakeholders the chance to discuss these differences and determine which method to use to calculate practice expenses, Moore said.

Teleradiology also remains a topic within the ACR's scope, particularly when the only limiting factor for moving large imaging data sets around the county - or the world - is bandwidth.

Moore said that teleradiology seems to be the trend, particularly given the subspecialty nature of radiology and the ability to get subspecialist readings almost instantaneously. The concern for the college is maintaining high quality.

While much consideration has been given to international teleradiology, there is also concern about the quality within U.S.-based teleradiology companies. Moore wants to ensure that the people who provide consultations on scans are highly qualified in their subspecialty and that teleradiology is not simply economically driven.

Moore, who is president of the 70-member Charlotte Radiology, is an interventional radiology CAQ examiner for the American Board of Radiology. He also is a clinical assistant professor in radiology at Duke University Medical Center.

Dr. James Thrall, radiology-in-chief at Massachusetts General Hospital, replaces Moore as ACR board vice chair. Thrall also serves as chair of the ACR commission on molecular imaging.

Borgstede, an associate professor of radiology at the University of Colorado at Colorado Springs, has been elected president of the ACR.

For more information from the Diagnostic Imaging archives:

ACR lobbies Congress to freeze budget cuts for two years

Stock offering signals technology tipping point

American College of Radiology clarifies role of its task force on teleradiology

ACR primer helps prepare for radiological terrorism