Radiology in the Value-based ACO Model

In the value-based accountable care organization (ACO) model, much focus is given to improving population health. Figuring out where radiology fits in is sometimes difficult.  

Today, health care focuses heavily on strategies for controlling costs by improving population health, concentrating on reducing congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, and diabetes. Beyond providing chest X-rays, diagnostic imaging isn’t heavily involved, but it’s frequently tagged as a high cost center, said James Whitfill, MD, chief medical officer for clinically integrated network Scottsdale Health Partners at RSNA 2016.

“You can argue that there’s a lot of other places to look for cost savings in population health,” he said. “But, as a radiologist, you should know that these high-tech metrics are oftentimes looked at first.”

Ultimately, though, imaging accounts for a small portion of health care spending. According to CMS, the typical Medicare Shared Savings Program (MSSP) spends $10,000 annually per patient. However, diagnostic imaging accounts for only $300 of that yearly total, he said. That low-level of involvement has left many industry leaders concerned radiology will be left on the outskirts of the ACO model.

One way radiology is trying to assert its impact is through clinical integration networks (CIN) – collections of providers, facilities, and post-acute care providers that partner to improve patient care and reduce overall health care costs. CINs can be part of the ACO structure, and, in some cases, the CIN precedes a larger move toward an ACO.

The Challenge
Even if you’re excited about leading your colleagues into an ACO model, it’s likely you’ll encounter some providers who are resistant to the idea, said Gary Dent, MD, president of South Georgia Radiology Associates, a network that recently made a move to the ACO model. It could be the biggest hurdle you’ll face.

“It can be a struggle to convince them that an ACO would be a benefit for the hospital,” he said. “And, prepare yourself that moving toward an ACO will be slower and more frustrating than you’ll imagine.”[[{"type":"media","view_mode":"media_crop","fid":"54502","attributes":{"alt":"James Whitfill, MD","class":"media-image media-image-right","id":"media_crop_7652137423181","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6825","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":"float: right; height: 170px; width: 170px;","title":"James Whitfill, MD","typeof":"foaf:Image"}}]]

Preparing Yourself
There are things you can do to better prepare yourself for this process, though, said Rodney Owen, MD, a private-practice musculoskeletal radiologist with Scottsdale Medical Imaging.

First, he said, you should develop a broad-based understanding of how the finances of your practice, facility, or department work. Second, foster a team-based mentality among your colleagues. You’ll experience greater success in an ACO if everyone approaches the endeavor as a unified effort.

“You’re all on the same team, and you have to be the team builder,” he said.

One Entity’s Experience
In 2010, Owen’s Scottsdale Medical Imaging took steps to move its CIN into an ACO. Today, Scottsdale is a 120-radiologist group that covers 16 hospitals and 34 imaging centers, and it also includes more than 700 primary care physicians.

From the outset, Scottsdale allocated 50% of savings to specialty providers and 50% to primary care physicians. It also became an MSSP in 2013. As an upside only facility, it receives incentives from the Centers for Medicare & Medicaid Services if it operates within its yearly budget, but it doesn’t face penalties for failure.

Because of radiology’s limited role with population health, Owen said, Scottsdale radiologists have made their impact as board members, as well as quality and information technology committee members. Through those roles, he said, radiologists have a direct impact on how well primary care physicians provide services to patients.

Whether you’re embarking on an ACO initially or are dipping your professional toes into a CIN first, you must make your presence known, Owen said.

“You have to participate, engage, oil the wheels, do what you think is right. Sub-specialize and be timely with your reports,” he said. “Invest in information exchanges and lower costs at inpatient and outpatient sites of service.”