Doing the Whole Job
Cat VaskoOn July 28, I was lucky enough to attend a physician-leadership learning track prior to the AHRA’s annual meeting in Minneapolis, Minnesota. The day got off to a running start with “Creating Sustainability in Medical Imaging: Defining and Rewarding Value,” presented by Rich Duszak, MD, CEO of the Harvey L. Neiman Health Policy Institute of the ACR®. After so many years of writing about radiology, I thought that I had a grasp of the basic facts of the profession, but Duszak was able to shock me—and, it seemed, others in the audience as well—with one key insight: Built into the CPT® codes (to which RBRVS amounts are assigned) for every radiology procedure are tasks intended to be completed before and after interpretations. “When you look at what we’re getting paid to do, the work description describes preservice work and postservice work,” Duszak notes. For example, the full CPT description of a CT exam of the thorax includes this preservice work: “The reason for the exam and any pertinent clinical history were reviewed, any prior imaging studies were reviewed, and the appropriate CT protocol for the exam was determined and communicated to the CT technologist,” he says. Further, in postservice work, the CPT description, according to Duszak, says, “The final report is reviewed and signed. Findings are discussed with the referring physician.” Duszak points out, “I know radiologists who will disconnect the phone from the wall so they don’t have to take phone calls, but we are being paid for this. Part of the reason we’re a target is that we’re not doing a lot of what we’re expected to do.” You read that right: According to the RBRVS, radiologists are supposed to be doing—and are being paid to do—this work, yet both the preservice and postservice descriptions sound an awful lot like that activities that thought leaders are urging radiologists to start engaging in on a regular basis. What’s more, we’re all well aware of the push back that they receive from physicians concerned with productivity, efficiency, and profitability. From Duszak’s perspective—as well as the perspective of the majority of those who make it their business to stay on top of regulatory and legislative changes to health care—the era of fee-for-service compensation is already ending, and the era of value-based care has begun. What we can learn from the long-disregarded preservice and postservice work built into the RBRVS is that adding value does not have to be a complicated proposition; the most difficult aspect of it will be coming to terms with the reality that no one is going to turn cartwheels in amazement if radiology becomes more consultative. Everyone expected it to be more consultative in the first place. Cat Vasko is editor of and associate editor of Radiology Business Journal.