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ARRS 2017: What do new payment models mean for radiology?

por Lauren Dubinsky, Senior Reporter | May 01, 2017
Business Affairs
Dr. Richard Duszak at ARRS 2017
“You guys are in this session rather than one of the clinical sessions because you’re interested in getting paid,” Dr. Richard Duszak, professor and vice chair for health policy practice at Emory University School of Medicine, said to a crowd of radiologists at the ARRS annual meeting in New Orleans.

In his session, “New payment models — what do they mean for radiology?,” Duszak outlined the ways radiologists can receive bonuses and avoid penalties under new payment models.

Although fee-for-service is still the dominant payment model, value-based models are already having an effect. Duszak stated that 85 percent of radiologists’ payments have some components of quality and value baked into them.
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Fee-for-service, pay-for-performance and accountable episodes are the three main payment models. The health care industry is currently a blend of all three models, explained Duszak.

“While you’re thinking about these new payment models, do not give up on the old payment models because they still remain the bulk of your payments right now,” he added. “That being said, we are in this new era of pay-for-performance moving forward.”

Former President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law in April 2015. It combined parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier and Medicare Electronic Health Record incentive program into a single program called the Merit-based Incentive Payment System (MIPS).

“There are so many metrics that are being thrown at us, particularly under MIPS, and all of these registered reporting requirements, and you have to document all types of reports,” said Duszak.

He’s an expert in this field and he even has a hard time remembering all of the reporting requirements. To prevent radiologists from signing reports with missing information, he recommends structured reporting templates.

Radiologists who got their bonuses in 2010 from Medicare under PQRS received an average of $2,800 at the end of the year. However, 76 percent didn’t get a bonus, largely because they failed to use structured reporting.

The consensus among radiologists and professional radiology societies is that they don’t want to deal with the CMS quality metrics, said Duszak. But he thinks this is an opportunity for the radiology community to innovate new quality metrics that professional societies can bring to CMS.

“If we don’t create our own metrics as a specialty, the people behind the metal desks at CMS will do that,” he added.

Going forward, the government and other societal stakeholders may make the quality metric scores visible on the public domain. If a radiologist didn’t satisfy their quality metric, a patient might see that information and prefer to go to another radiologist.

“I think it’s not going to be the strongest physician practices that survive, or the most intelligent, but the one that’s the most responsive to change,” said Duszak. “The way that we are going to respond to change is by paying attention to all of this wonky stuff that is overloading us, figure out who the physician champion is in our practices, [and giving them] the support and time to put this stuff into practice and then following their lead.”

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