Radiologists Urged to Adopt Value-Based Pay Model Regardless of Obamacare's Future

By Paul LaTour

Thomas Greeson, J.D., and Cynthia Moran.

Regardless of ongoing controversies surrounding the Patient Protection and Affordable Care Act (ACA), the fee-for-service payment model will continue to be diminished, according to a panel of experts who convened Wednesday for an RSNA 2014 refresher course, "The Affordable Care Act: What Does it Mean for Radiologists and Radiology?"

In fact, the demise of the fee-for-service payment model may be the only thing politicians and policymakers agree about related to the ACA, also known as Obamacare, experts said. "The idea that fee-for-service is unsustainable for the long term is a commonly held belief among all policy makers regardless of their political party identity," said Cynthia Moran, executive vice-president of American College of Radiology (ACR) and an expert in government relations, economics and health policy.

"We don't know quite where we are going, but we do know that Congress and policymakers—regardless of who is in the White House—are going to make it more and more uncomfortable to stay in a fee-for-service, volume-driven payment scheme," Moran said.

Moran noted that attempts at a full repeal of ACA by Republicans would fail due to the veto power of President Obama, despite the party's upcoming majority in the House of Representatives and Senate in the 114th Congress. Certain areas are ripe for repeal, however, especially those in which there is some support from Democrats such as the elimination of the Independent Payment Advisory Board (IPAB), which decides how Medicare can save money without affecting coverage or quality.

"If you lost that ability to interact with Congress on health-policy decisions, I think that would be a travesty that would very much disenfranchise the American College of Radiology, its members, and radiologists in general," Moran said.

Empowering Radiologists with Data is Goal

Discussions involving the shift to value-based payment models aren't going to be happening in the future—they are happening now, emphasized Ezequiel Silva, III, M.D, vice-chair of the ACR Commission on Economics and an advisor to the Relative-Value Scale Update Committee (RUC), which has worked to quantitatively define value with some critical claims-based data measure.

"The challenge to get that data into the hands of radiologists has never been greater, and it's something the college (ACR) takes very seriously," Dr. Silva said, adding physicians want to adapt the new payment model without financially crippling their practices. "It puts physicians from a physician-payment perspective into an awkward middle ground," he said.

The ACA has presented radiologists and all physicians with a new landscape in which to provide their services, which was going to happen with or without the ACA, said Thomas Greeson, a healthcare regulatory lawyer and former general counsel for ACR. That landscape includes programs such as the Medicare Shared Savings Program (MSSP), the Hospital Quality Efficiency Program (HQEP) and the Physician Quality Reporting System (PQRS).

Radiologists must do everything they can to build their relationship with hospitals to demonstrate their value, Greeson said. "You want them to be your ally when they are working on those payment negotiations," said Greeson, a partner with Reed Smith, LLP in Falls Church, Va.

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