As the “volume to value” movement reshapes healthcare economics across the U.S., radiology is reminded daily that it is by no means exempt from the new and somewhat nebulous fiscal demands. More vexing still, radiology, unlike other medical specialties, “won’t fit into the standard definitions of value that apply to specialties with more face-to-face interaction with patients. Going forward, radiology’s challenge is going to be: How do we define our value?”
Those are the words of Mike Mabry of the Radiology Business Management Association. In February he will mark his 10th anniversary as RBMA’s executive director. In October he took questions from Medical Imaging Review on the state and outlook of radiology from the vantage point of its changing bottom line. Here are excerpts from that interview.
Q. What was the biggest development for radiology in 2015, and how did it affect the way the profession is managed as a business?
Mabry: The single biggest development in 2015 was [the passage in April of] MACRA, the Medicare Access & CHIP Reauthorization Act (aka the “permanent doc fix”). Short-term, this replaced the sustainable growth rate (SGR), and, hopefully, over the next several years, we are going to have relatively stable Medicare fee schedules without the threat of a looming 20% to 25% cut in the fee schedule every year.
The other thing MACRA did was take some of the pressure off of radiology always being the “pay-for” for an SGR fix. That doesn’t mean radiology won’t be a pay-for going forward, but for now it takes away one more excuse for Congress to go looking to wring more savings out of radiology. We always had the annual SGR fix, and we always said, “Okay, where are they finding the money to pay for this? Oh, they’re doing something to radiology—again.”
MACRA also moves Medicare payments into the Merit-based Incentive Payment System (MIPS) and alternate payment models (APMs). So it’s definitely moving Medicare payments into the value space. How can radiology fit into the new paradigm of value-based payments created under MIPS and APMs? Going forward, I think that is going to be a challenge and an opportunity for radiology.
Q. What do you think will be the single most challenging business issue for radiology practices in 2016?
Mabry: Again, it’s the whole move toward value and value-based payments. CMS has already set goals for percentages of payments paid in a value-based system. We are going to see how MIPS and APMs fit in to the Medicare fee schedule and payment systems next year. They are probably going to come out with a proposed rule in early 2016. With that we’ll know a lot more about how radiology fits in.
Plus, ACR has its Imaging 3.0 initiative, where they are encouraging radiology practices to demonstrate their value. So I would just stress that the biggest business challenge for next year will be showing and documenting value.
Q. Might radiology leverage its unique place in the value equation to regain its reputation as the highly valued “doctors’ doctor”?
Mabry: I do see that, and I think two things will help set that stage. One is clinical decision support. The other one is, can radiology provide a definitive diagnosis that is cost-effective? Can radiology be the gatekeeper for imaging? Can radiologists take greater ownership of imaging utilization? Can radiology be the source for choosing the right test for the right patient at the right time?
Q. What will be radiology’s biggest compliance burden in 2016?
Mabry: I would say clinical decision support. Although CMS announced a delay in the consultation requirement that would have gone into effect on January 1, 2017, there are still a lot of moving parts and work to be done to get ready. First we need to get some implementation guidance from CMS around how they want this information communicated for payment purposes. Second, that information should be automated so that it is seamless and efficient from ordering physician through rendering facility, rendering provider and on to Medicare.
That means the referring physician needs to be talking with the radiology systems, which need to be talking with the facility systems, which need to be talking to the billing and coding systems and the claims submission systems. All of those things will need to be talking together. The additional time also should be used to dialogue with ordering/referring physicians and rendering facilities to understand their concerns and address them together.