The spread of the accountable care organization (ACO) model has sparked legitimate causes for concerns among radiologists, but these threats will be lessened if radiology groups shift from a “film reader” mentality to emphasizing added value to a larger organization, according to an article published in the December issue of the Journal of the American College of Radiology.
“Although the anticipated rise of accountable care organizations brings certain potential threats to radiologists, including direct threats to revenue and indirect systemic changes jeopardizing the bargaining leverage of radiology groups, accountable care organizations, and other integrated health care delivery models may provide radiology with an important opportunity to reassert its leadership and assume a more central role within health care systems,” wrote Richard G. Abramson, MD, of Vanderbilt University in Nashville, Tenn., and colleagues.
The challenge for radiology groups, according to the authors, largely comes from diminished autonomy and potential revenue losses that may result from the new payment models being used by ACOs. Per-scan reimbursements could drop compared to fee-for-service revenues and integrated care organizations may limit expenditures by clamping down on imaging service utilization. The bonus payments from ACO shared savings arrangements must be negotiated by all participants, and these bonuses may not offset declining revenues, warned Abramson and colleagues. Moreover, groups that meet their target benchmarks may still be penalized by poor financial performance of the larger organization.
To avoid being forced into an unfavorable situation, Abramson and colleagues suggested radiologists take a more active role in organizational leadership and actively promote contributions in four areas:
Utilization and decision support – Radiologists possess special expertise in the appropriate selection of image-based procedures, and the authors suggested this knowledge could be leveraged to promote cost-effective utilization of clinical services. “Involvement in clinical decision support should be seen as a natural outgrowth of radiology's core consultative role and may not be limited solely to imaging. Indeed, radiology's unique position at the nexus of the healthcare continuum may facilitate its broad participation in patient triage, including access to specialist services,” they wrote.
IT leadership – For ACOs to be successful, they must integrate patient personal health records, EMRs, case management software and administrative databases, and Abramson et al argued that radiology’s leadership in health IT would guarantee a “seat at the table” for influencing organizational decision-making.
Quality and safety assurance – Radiologists in many organizations already assume responsibility for quality and safety assurance, providing particular focus on administering radiation safety programs and designing contrast administration policies. “Radiology groups would be well served by highlighting these contributions and may derive benefit from expanding into other areas of quality assurance,” wrote the authors.
Operational enhancements – Abramson and colleagues added that other areas where possible radiologist input could optimize workflow include emergency department and hospital discharges, cost-effective billing solutions and establishing protocols for secure transfer of imaging data.
“Given the critical imperative for radiology to evolve from a transactional to a systemic role in health care, our profession may ultimately benefit from the rise of ACOs as the catalytic event that forces us to redefine our own identity.”