Preparing Radiology For Alternative Payment Models

On January 26, 2015 the Department of Health and Human Services (HHS) announced two ambitious goals that have a significant impact on radiology: One half of all Medicare payment to physicians and hospitals will be made through alternative payment models (ie, medical homes and accountable care organizations) by 2018 and 85% of all fee-for-service payments will be tied to quality or value by 2016, with 90% by 2018. Shifting from fee-for-service reimbursement in Medicare to a pay-for-performance model has been long been an aspiration of HHS. However, this is the first time HHS has set explicit numerical goals for alternative payment models and value-based payments. Secretary Burwell also announced the creation of a Health Care Payment and Learning and Action Network that will work with private health insurers, providers, employers, and state Medicaid programs to hasten the spread of alternative payment models outside of Medicare. The American Medical Association and the American Academy of Family Physicians (AAFP) have voiced their support for this plan moving forward.

This announcement leaves many radiologists and their practices wondering how they can contribute to the formation of alternative payment models that are beneficial to the specialty.  What will radiology reimbursement look like in a value-based world? And what is ACR doing to help its members thrive under these new payment structures?

The Center for Medicare and Medicaid Innovation (CMMI) has a number of ongoing demonstration projects designed to give the Centers for Medicare and Medicaid Services (CMS) data to assess which alternative payment models are really demonstrating savings and look promising enough to move forward.  Have you been to the CMMI website to find out which ones are happening in your state and how your practice is affected? The ACR Radiology Integrated Care (RIC) Network has been reaching out to radiology practices that we have self-identified as affiliates of Pioneer ACOs and the Bundle Payment Care Initiative (BPCI) to get our members’ perspectives on these new payment constructs. [[{"type":"media","view_mode":"media_crop","fid":"32039","attributes":{"alt":"Pam Kassing, Senior Economic Advisor, ACR","class":"media-image media-image-right","id":"media_crop_6291863298039","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3386","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: 241px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Pam Kassing, Senior Economic Advisor, ACR","typeof":"foaf:Image"}}]]

The ACR-supported imaging provisions in the Protecting Access to Medicare Act (H.R. 4302) that require hospital outpatient facilities and physician offices to use clinical decision support (CDS) tools to help determine appropriate use of imaging, encourage physician consultation, and promote the use of patient portals. 

As we transition from volume- to value-based care, radiology’s ability to ensure appropriate imaging and efficient use of resources may very well be a factor in imaging reimbursement in new delivery and payment models. Decision support tools can help radiology professionals carry out these new types of roles. The College’s support of the new law is another indication to CMS that radiology will serve an important role in alternative health care models, can contribute savings, and help provide better patient care. There are already pioneer radiology groups that have implemented CDS into their hospital systems and care networks and have documented significant progress in ensuring appropriate care. Others are in the process of implementing similar systems.   

ACR’s Imaging 3.0 initiative provides guidance and tools to radiologists who are making the move from volume- to value-based care for their patients. Under the leadership of Bibb Allen, MD, current chair of the ACR’s Board of Chancellors, the ACR is implementing a bold strategy that provides a roadmap for radiologists to demonstrate value to payers, referring physicians, and patients. Starting with CDS to ensure the right test is ordered for the right reason at the right time and culminating with a structured, actionable report that can be used to collaboratively plan next steps in the care process, Imaging 3.0 radiologists are focused on transformational change that marries patient-centered practice, quality measurement, and enabling technology supported by case studies, business plans, structured terminologies, quality improvement templates, and vendor-neutral technology solutions. Defining and measuring value to ensure alignment of appropriate incentives is a key endeavor for ACR’s Quality and Safety Commission. By defining and validating numerous radiology measures and developing registries under the National Radiology Data Registry (NRDR) program, all of which are approved by CMS for reporting quality measures, ACR offers radiologists multiple pathways to demonstrate value.

ACR’s Harvey L. Neiman Health Policy Institute offers evidence-based policy recommendations and access to tools such as the Inpatient Imaging Information ( I³ ) app. The I³ app aggregates multiple years of Medicare inpatient claims data and allows the user to examine both hospital and imaging costs across inpatient diagnosis related groups (DRG). The recently launched Neiman Almanac aggregates multiple years of data from varying data sources to create dynamic tables of both state and national figures on volume, spending, access and workforce of radiology services. This resource is available to the radiology community as we work together to define radiology’s place in value-based care.