Swinging the Pendulum

Leaders note the College’s progression from where it’s been to its agenda for the future.

During his talk on economics, Bibb Allen Jr., MD, FACR, chair of ACR Commission on Economics, asked the audience, “What do you consider radiology’s biggest challenge to maintaining fee-for-service (FFS) reimbursement?” Using an interactive-response system, most replied “CMS [Centers for Medicare and Medicaid Services] methodological and regulatory changes.” When asked next what they would like the ACR to do to protect reimbursement, many attendees felt that the College should continue a vigorous defense of radiology FFS payments at the Relative Value Update Committee (RUC) as well as develop solutions outside the fee-for-payment structure.

The ACR, Allen explained, will continue to defend the FFS payment system and explore other payment models. However, even if payers adopt other payment models, it’s unlikely that such a change would happen overnight. Additionally, he said, “many imaging services may be difficult to reimburse in another system, and challenges will still occur on a code-by-code basis.” Fortunately, he believes the ACR, and, specifically, the Commission on Economics and its various committees are uniquely positioned to continue this battle for FFS and reimbursement.

Several representatives from those economic committees gave presentations during the meeting on activities they’ve undertaken in the past year, and on opportunities and threats still to come in specific areas like coding and reimbursement.

Ensuring Codes’ Survival With the RUC
Daniel Picus, MD, FACR, RCC, chair of the ACR Committee on Coding and Nomenclature (C&N), reported a busy year for C&N with 42 new codes, 30 deletions, and 25 revisions related to radiology that are expected to go into effect January 2011. However, while new codes are, on the whole, positive for radiology, the development of new codes doesn’t come without risk.

“Once a code is approved by the editorial panel, it moves to the RUC,” said Picus. “When a new code is valued, we’re usually asked to bring the entire family of related codes back to the RUC. Those existing codes rarely survive the original valuation.”

As for the future of coding, Picus believes radiology is in good shape. “While radiology is facing many ongoing challenges in coding, the specialty is well-represented in the CPT process with a coalition of societies led by the ACR,” he said.

Working with the RUC, Zeke Silva III, MD, FACR, chair of the ACR Practice Expense Committee, regularly presents practice-expense inputs to the RUC Practice Expense Subcommittee. The work within Silva’s committee takes a lot of time and effort. For example, discussions with RUC involve deciding on direct expenses to practices, such as staff, equipment, equipment time, and supplies.

This monetary determination for direct expense represents the baseline of the committee’s activities. “Every time a new code goes to the RUC, we go to the table and present the practice-expense input used by the physician providing the service,” Silva said. “For example, we’ll argue whether a particular service involves one pair of sterile gloves or two.”

Value of Imaging and the ACR
And yet the more things change, the more they stay the same. Managed care payers, said Mark O. Bernardy, MD, FACR, chair of the ACR Managed Care Committee, still don’t really understand the technology used by radiologists in imaging. To address this, his committee began creating webinars to educate those managed care payers. “We wanted to explain to them in a simple way the high-tech stuff that they don’t comprehend,” he said.

“The first webinar was on PET [positron emission tomography] in April, and we invited managed care directors from across the country to participate,” he said. The next webinar the committee will produce is on computed tomographic colonography, then mammography, followed by intensity-modulated radiation therapy, and then proton beam therapy. “We’re going to do as many as we can to educate these individuals,” he added.

Educating for the masses was a popular subject of several presentations at AMCLC. For one of the last sessions, Silva teamed up with Richard Duszak Jr., MD, FACR, to provide a value assessment of ACR membership, posing the question, “What has the ACR done for you lately?” Duszak related ACR’s ability to change policy to entropy, a term used in thermodynamics. Entropy is a measure of how much a system is disorganized. Duszak said, “Without putting energy into a system, things fall apart.”

Referencing the ACR membership dues increases, which were approved for $795 in 2011 and $850 in 2012, Silva discussed the equipment utilization assumption, which, with ACR’s help, was decreased from 90 percent to 75 percent. “There are about 4.5 billion RVUs from the practice-expense side, and a nine percent gain for practices,” Silva said.

“We may have to accept a new payment paradigm the same way we did in the 90s,” Silva continued. “However, I firmly believe that we need to remember that at the end of this cash stream is the patient. You want patients as your advocates.”

Continuing the discussion of swaying patients to become believers in radiology, Alan D. Kaye, MD, FACR, showed a video from the 1999 Institute for Healthcare Improvement National Forum by Donald Berwick, MD, MPP, who relayed his personal experiences with errors, poor quality of care, delays in treatment, and lack of information during his wife’s treatment for an autoimmune spinal cord disease. Berwick witnessed inconsistencies in a variety of services, often including daily mistakes in medication dose and frequency. “People [in health care] need to talk to each other,” he said on the video. (You can view Berwick’s entire discussion at http://bit.ly/b43shT.) Using the video as a jumping-off point, Kaye stated that “any dominant industry can be displaced” and used the example of cork wine stoppers versus plastic wine stoppers. Manufacturers of cork wine stoppers, “a 400-year-old industry, dropped from 100-percent market share a decade ago to 69 percent today,” Kaye said. “And that’s us. Successful companies provide not what they want to provide but what their customers want.”

Extending the metaphor, Kaye contrasted the examples of Amazon.com and Starbucks, which “elevated everyday products to the point that the public was willing to pay extra for them,” with Walmart, “which uses its market power to lower prices,” he noted. “It doesn’t rest on its exclusive contract but rather works to make things better for its customers.”

“My motto is a quote from Darwin: ‘It’s not the strongest of the species that survives, nor the most intelligent that survives. It’s the one most adaptable to change.’ That’s how radiology needs to think as well.”

For helpful materials to assist you in educating your patients regarding the unique training and education of radiologists and the important role that radiologists serve in providing quality care, please visitwww.MyPatientConnection.com – one of the two websites created for the “Face of Radiology” branding campaign. Please refer your patients to the campaign’s patient facing website, is www.MyRadiologist.com.

ACR 2010-2011 Election Results
Many positions were voted on during the AMCLC, and the following individuals have been elected to serve in various leadership roles.

President
James H. Thrall, MD, FACR, from Boston, MA

Vice President
Lawrence P. Davis, MD, FACR, from New York, NY

Board of Chancellors
Gerald D. Dodd, III, MD, FACR, from Aurora, CO

Council Steering Committee
Mark J. Adams, MD, FACR, from New York, NY
Edward I. Bluth, MD, FACR, from New Orleans, LA
Alan H. Matsumoto, MD, FACR, from Charlottesville, VA
Richard Strax, MD, FACR, from Houston, TX

College Nominating Committee
Jocelyn D. Chertoff, MD, MS, FACR, from Lebanon, NH
Steven M. Cohen, MD, FACR, from Westport, CT
John W. Rieke, MD, FACR, from Tacoma, WA

Members-in-Training
Jason N. Itri, MD, PhD, from Cherry Hill, NJ
Karen B. Weinshelbaum, MD, from Bronx, NY

ASTRO Representative
The CNC, in consultation with the Chair of the BOC, selected Albert L. Blumberg, MD, FACR, from Baltimore, MD, to serve a second three-year term on the BOC as the representative from the American Society for Radiation Oncology.

Private Practice Representative
Richard A. Szucs, MD, FACR, from Midlothian, VA, was elected for one two-year term as representative to the Intersociety Summer Conference, as effective in July 2010.

Review the Resolutions
Want to know what resolutions passed and which ones didn’t? Find the complete list of resolutions online athttp://amclc.acr.org.