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.
Q. That challenge sounds more technical than clinical or even business-related.
Mabry: Yes, CDS is an IT challenge and opportunity. How can you connect an EHR to a RIS to a scheduling system to a billing system so that information is captured once and flows through the system? The good news is, radiologists have always been on the forefront of technology, with digital imaging and RIS and PACS. I think radiology, probably more so than other specialties, is well positioned for these kinds of technology challenges. Radiology is a technology-driven profession, and radiologists have the knowledge, the systems and the personnel to make CDS happen.
Q. How might the 2016 elections impact healthcare’s future, and where will RBMA focus its health policy efforts in 2016?
Mabry: From an RBMA perspective, the 2016 elections really aren’t going to change our focus. Whether the Republicans hold onto Congress or the country elects another Democratic president, or whatever, our focus from a health policy standpoint will largely remain unchanged. And what we are going to be focused on next year is clinical decision support implementation, helping to promote radiology’s value and helping to align radiology with MIPS and APMs. Regardless of what happens in the 2016 elections, those three areas will have our attention throughout 2016.
Any effects of the elections won’t be felt until 2017 at the earliest, anyway. Even if major developments come into focus, including something like the repeal and replacement of Obamacare, those are really long-term developments. You really can’t make plans this far in advance. Who knows the future?
Q. Do you feel there is strong enough leadership in radiology to make sure it plays a major role in shaping the transformation from volume to value?
Mabry: The leadership is evolving and rising to the occasion. We are seeing a greater emphasis on value within the profession, not just from outside of it. Looking at what ACR is doing with Imaging 3.0, radiology business managers are working with that and doing their own things to help advance value and quality. I think the core leadership is there, and we’re beginning to see it rise to the service.
Q. Can you cite an example of leadership in action that you recently observed?
Mabry: Well, echoing back to clinical decision support, there you have an initiative that radiology brought to Congress. That was a proactive strategy involving many in the radiology community going to Washington and saying, “Look, we have a solution. Show some faith in us and trust us to help manage this issue, so that we can do a better job assuring that the right patient gets the right test at the right time.”
Another example: Radiology is working with hospitals to make imaging more efficient and save the hospitals money. At RBMA’s fall educational conference, we had our value innovation lab. We showcased six case studies on how radiology is adding value through integration, clinical decision support, price transparency, subspecialty reads and more.
Since this is for Medical Imaging Review, I’ll mention that vRad showcased ways to use data to demonstrate quality and value. We had more than 100 attendees at some of those innovation sessions. So there is a great desire, a great thirst within radiology groups, to learn what other groups are doing in the value space.
These case studies are finding a very receptive audience because everyone agrees that there is opportunity, and these value innovators are showing everyone the way.
Read more: RBMA’s Innovations in Radiology Value
Q. After 10 years at the helm of RBMA, what will you most look forward to in 2016 and beyond?
Mabry: The chance to see radiology get back to being the doctors’ doctor. I am encouraged watching radiologists realize that they add a lot of value by providing definitive diagnoses that save money in the long run. Going forward, being the doctors’ doctor will mean radiologists reinventing themselves—appreciating that patients, referring physicians, hospitals and payors are all looking for value.
Radiology is evolving and reorienting itself in that direction. It’s not static. Nobody is resting on their laurels. Nobody is saying, “We’re going to keep doing things the way we’ve always done them.”
There will always be some of that in every industry. But I think there is a recognition that the times are changing, and radiology needs to be helping to effect that change—rather than allow change to be thrust upon them.