15 minutes with incoming RBMA president Christie James

Health Imaging caught up with Christie James, MS, president-elect of the Radiology Business Management Association, at an RBMA regional meeting last Friday. (For the record, the event was the annual meeting of the group’s New England chapter in Somerville, Mass.). James, whose fulltime job is operations manager of radiology revenue cycle management for the Massachusetts General Physicians Organization, begins her 2018–19 tenure next April.

HI: What to-do items do you expect to have as your priorities for RBMA on day one as national president?

JAMES: I just got out of a strategic planning session with our board. We went back and looked at our three-year plan as we head into its third year. We had a consultant come in, and we worked very hard for two days. We came out with a priority of education for our members. Our priority is keeping them abreast of the changes we heard about today—AI, legislative challenges, coding changes, healthcare economics and policy, proposed Medicare rules and key state and federal advocacy issues for imaging.

RBMA is in a unique position to educate our members about a broad range of topics. We want to get out and educate them on how to position their practices in a timely way, because healthcare is changing quickly.

How well-informed is the RBMA membership on CMS’s Quality Payment Program—MACRA, MIPS, advanced APMs and so on?

We have been keeping our membership well informed about QPP. I think our focus with CMS is more about site neutrality for all our members, facility or non-facility based; it’s more about the AUC (CMS’s Appropriate Use Criteria program) for advanced diagnostic imaging. There is a lot of controversy around AUC and how it will be implemented. RBMA has a position on it, and obviously ACR has a position on it. I think we need to advocate for it. We all have to work together to make sure it gets implemented in 2019. That’s one of the goals at the forefront of our priorities: providing appropriate imaging at the right time for our patients.

A lot of our members know little about AUC and what it means to their practices. One of the things I’d like to do is start looking at the referral bases and educating referring physicians on AUC. We have implemented this thing, but we really haven’t told the people who are going to use it what it’s all about.

I’m immune to it, because we developed AUC here at Massachusetts General Hospital, where I work. We’ve been using it since 2004. But there are a lot of places around the country that have not used it yet.

When you talk about site neutrality, is it in the context of Anthem’s pushing all outpatient MRI and CT exams to nonhospital settings?

Site neutrality has a couple of different aspects to it. Anthem is adopting a site neutrality [position], but I look at it differently. Anthem has decided they’ve got to lower costs, and the way they’re lowering costs is by saying that the emergency department has to get authorization from AIM Specialty Health, which is part of Blue Cross Blue Shield and is sort of their RBM.

A lot of radiologists and radiology managers are concerned about that. We are concerned for the patient—not necessarily over whether we’re going to lose money or anything like that. We are concerned for the patient and the continuity of care. That’s our number one priority. If we have to send a patient elsewhere to get that CT or MRI, that often stops the continuity of care.

What are some of the challenges RBMA faces as an organization that you may look to address?

We just need to get the word out there that RBMA is a resource for the business of radiology. We’re here to help practice managers, industry, imaging centers, independent diagnostic testing facilities—anyone who is involved in radiology. RBMA is their go-to for business education and for positioning their practice for the future.

We’re about to embark on our 50th year. We now have a membership of about 2,300 and we want to grow. That’s also one of our priorities—growing through education, through marketing, through leadership at regional chapters. We want to make sure people in our chapters are aware of RBMA national and the many resources we provide to help members manage their practices effectively and efficiently.

There were quite a few non-members here today in our regional chapter meeting; we hope we can get them to become members. Also, through our chapters we want to be participating more with the radiological societies so we can have more collective unity for bringing imaging into the 21st century.

Does RBMA have a working relationship with AHRA?

Yes. We have liaisons who work with AHRA, which is one of the associations we work with in the radiology space. We also work closely with ACR. We expect the January 2018 ACR-RBMA Practice Leaders Forum in Phoenix to be very well attended.

You had a session on AI today. What aspects of this technology are important to radiology business managers?

Here’s an example. I’m working with a brilliant scientist here at Massachusetts General on the predictability of billing and denial management. He’s taking AI out of the clinical space, and we’re taking it more into the revenue cycle space. He is after big data, so I will give him big batches of data. Then I’ll be working with him to educate his AI on the predictability of denials and so on. It’s pretty slick.

And AI is probably not going to replace radiology business managers any more than it’s going to replace radiologists—at least, not while our generation is still working. Right?

Right. And I don’t think we’ll see what I just described in the next five to 10 years. But it’s interesting—I love meeting with the residents and fellows now. Today’s residents are skeptical about what’s going on with AI, but they’re used to technology. They have a lot of energy and they’re very curious about revenue cycle management, believe it or not. We are giving them an introduction to revenue cycle management during their third year of residency. It’s inspiring and fun.

I’m looking forward to the future, because AI and the other things we talked about at today’s meeting are moving forward at a fast pace. I enjoy the challenge of it all, making sure our membership is well-informed so they can position themselves and their practices accordingly, from a business perspective. At the same time, we’re ensuring we provide the best healthcare possible for our patients.