Subspecialty Access in an Era of Value-Based Payment

By Bill Pickart, CEO

When President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law, he effectively transformed U.S. healthcare into a system in which value trumps volume. With a new reimbursement framework in place, providers must adjust their business and care models accordingly.

Beginning in January 2017, the Merit-based Incentive Payment System (MIPS) will begin assessing Medicare physicians’ performance by developing a Composite Performance Score (CPS) based on four elements: Quality (weighted 50 percent of total score), Advanced Care Information (25 percent), Clinical Practice Improvement Activities (15 percent) and Cost (10 percent). This new payment system aims to streamline and simplify the three previous CMS quality programs known as the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM) and the Electronic Health Record Meaningful Use (MU) program, and will affect payments beginning in 2019.

While the transition to value-based care will accelerate come January, we have already seen swift progress toward adopting this new model; by 2018, 90 percent of fee-for-service payments are expected to be tied to quality and value programs. But how does this directly impact the radiology department, and what can radiologists do to better prepare for these upcoming changes?

Radiology’s unique position

With this increased focus on providing higher quality care more efficiently and cost-effectively, the specialty of radiology is uniquely positioned to play a pivotal role in the U.S. healthcare system’s transformation. Imaging touches nearly every major disease and is often the first step toward diagnosis, therefore playing a critical role in patients’ entire care and treatment process. Unsurprisingly, according to a 2015 Malpractice Report by Medscape, more than two-thirds of the medical malpractice lawsuits faced by the radiologist respondents stemmed from a failure to diagnose.

In addition to being the first step toward an accurate diagnosis and effective treatment plan, radiology is a costly burden on the overall system: According to the American Academy of Orthopedic Surgeons (AAOS), the United States spends $100 billion on diagnostic imaging annually, making it the second-largest—and fastest growing—item for healthcare payors. The AAOS also estimates that $30 billion of this spend is unnecessary, caused by inappropriate utilization of imaging or duplication of studies.

In an era of value- and quality-based reimbursement, radiology groups can reduce costs and waste while improving patient outcomes through greater access to trained subspecialists.

Subspecialty access is key

Greater access to subspecialists has become crucial to providing the highest quality of care to the hospitals, surgery centers and communities that radiology groups serve. Research proves subspecialists provide more accurate diagnoses for certain tests, therefore leading to improved patient outcomes and reducing the need for timely and costly duplicate tests. For example, a study published in the Radiological Society of North America (RSNA) Radiology journal found that radiology subspecialists made more true-positive and fewer false-positive interpretations at screening mammography, with significantly higher cancer detection rates than their general radiologist counterparts.

And yet, a 2006 study published by the American College of Radiology (ACR) found that only 30 percent of all mammograms are interpreted by breast imaging specialists, signaling a critical need for greater access to these specialists.

But pairing the demand for subspecialty-trained providers with the providers themselves can prove a daunting challenge for many groups across the country. According to a 2013 article published in the Healthcare Financial Management Association’s (HFMA) Strategic Financial Planning, 93 percent of the United States’ 3,000 radiology groups have 10 or fewer providers, significantly limiting their ability to access subspecialists when needed.

An alternative solution

Previously, these groups were faced with few options: try to continue forward despite the industry’s increased competition and regulatory pressures, or be acquired by a national single- or multi-specialty management company, such as Radisphere Radiology or Sheridan Healthcare, to gain the economies of scale and subspecialty access required to survive in an increasingly demanding market.

But emerging technologies and collaboration models are beginning to disrupt the landscape and provide radiology groups an attractive alternative to these options. Rather than sacrificing their clinical autonomy through acquisition, radiologists can facilitate greater subspecialty access through modularized, cloud-based technologies and collaborative business models for noncompetitive groups.

At Integrated Radiology Partners (IRP), our model of collaboration helps foster the growth and success of independent, like-minded radiology groups. By pooling resources, gaining economies of scale and greater access to subspecialists, our group collaborations achieve valuable tools to optimize their clinical operations and outcomes without sacrificing their autonomy.

 

To learn more about increasing access to radiology subspecialists or IRP’s group collaboration model, please email ContactIRP@IntegratedRP.com.