Improve population health. Optimize the patient experience. And do both while cutting costs. That, of course, is the “Triple Aim,” the Institute for Healthcare Improvement’s boiled-down recipe for putting the Affordable Care Act into action at the provider level. And where does radiology fit into the formula?
As an optional or even undesirable added ingredient.
At least, that may have been the perception up to now. But times are changing, writes Geraldine McGinty, MD, MBA, Weill Cornell Medicine, New York City, in the opinion pages of February’s American Journal of Roentgenology.
“To date,” she writes, “those of us in radiology may have been feeling as if we have been left out of the conversation and even, perhaps, unfairly targeted as part of the problem; however, our opportunity to participate in and even drive value-based health care models is emerging, and it is incumbent upon us to make the most of this opportunity.”
Tracing the present momentum to the April 2015 passage of the Medicare Access and CHIP Reauthorization Act (MACRA), McGinty bids farewell to the repealed and “almost universally despised” sustainable growth rate payment formula.
She projects the stabilization of Medicare payments over the next five years, albeit with minor annual updates.
“During that time, the healthcare delivery system is tasked with developing new payment models that will recognize and drive value,” she writes, adding that, by 2022, some 9 percent of providers’ payments will be at risk, courtesy of MACRA’s Merit-Based Incentive Program (MIPS).
Or compensation could swing the better way, offering providers a chance to earn a 5 percent bonus, as long as the provider elects to participate in a MACRA-approved alternative payment model (APM).
(For more on MIPS and APMs, click here.)
MIPS will incorporate all the government’s existing value-based payment programs, including the Physician Quality Reporting System, McGinty writes, “but there is a new category of performance, known as ‘clinical practice improvement,’ that we anticipate will recognize many of the Imaging 3.0 activities that radiologists have been embracing without monetary reward, such as enhanced collaboration with other providers and communication with patients.”
How will the chance to participate in the APM program affect radiologists? By opening an avenue to even more input from the imaging community.
“We know that, even in the pioneer ACOs, the radiologists are typically paid on a fee-for-service basis and often still have their relative-value-unit productivity measured,” she writes. “[H]owever, we have been actively seeking input from innovators from around the country to help formulate our vision of what a radiology APM should look like.”
Pointing to the American College of Radiology’s case study of a radiology-led ACO in Kansas and a pilot shared-savings program based on appropriate imaging between a radiology group and their emergency medicine colleagues, McGinty encourages her fellow rads to see for themselves that “there is plenty to inspire us from within our own community.”
“Even if radiologists have not been appropriately paid for the value we have delivered in the recent past, we have certainly delivered value both to our patients and to the healthcare system,” she writes. “Realigning payment policy to recognize the value that imaging provides is a priority. To ensure that innovation in medical imaging will continue, we cannot afford to miss this opportunity.”