Medicare Physician Fee Schedule Final Rule:
Impact on Radiology, Part 2

By Douglas G. Smith, FRBMA, Managing Partner of Strategic Positioning & Consulting Solutions


As a follow up to our first blog post regarding the 2017 Medicare Physician Fee Schedule highlights, you will find additional information and details below:

New Bundled Mammography Codes

CMS will also not make any changes to the technical component (TC) reimbursement for mammography with CAD, but CMS is changing the code definitions to match the 2017 CPT® codes. For example, code G0202 will now be defined as “screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed” to match code 77067. The G codes will be used for both digital and non-digital mammograms. CMS expects to switch over to the CPT® mammogram codes in 2018.

CMS accepted the mammogram work RVUs proposed by the RUC (Relative Value Unit Update Committee) but is not accepting the practice expense RVUs as this would result in drastic payment cuts. Instead, CMS will use the PE-RVUs from the G codes. CMS notes in the Final Rule that there will not be significant payment reductions for mammography in 2017.

Reimbursement Reductions for Plain Film X-rays

CMS has demonstrated over the past two years its commitment to getting digital images into the EMR. While some entities may choose to take a hit in 2017 rather than make the capital investment in digital radiology, the penalties in the coming years may warrant the investment.

Delayed CDS/AUC Implementation

After consulting the appropriate use criteria (AUC), the ordering professional must communicate the results of the AUC consultation to the furnishing professional (imaging facility) at the time the advanced imaging study is ordered. CMS stated in the Final Rule it does not intend to establish any requirements as to how this communication takes place.

The furnishing professional is in turn required to report the results of the AUC consultation on the Medicare claim for the imaging exam, and CMS expects this requirement to go into effect on Jan. 1, 2018. CMS is considering various mechanisms for this reporting, including HCPCS G codes and HCPCS modifiers.

By 2020, the Protecting Access to Medicare Act (PAMA) requires that CMS identifies “outlier” order professionals who consistently fail to follow AUC recommendations. These outliers will be required to obtain pre-authorization for advanced imaging exams.

Ordering professionals will be required to consult AUC for all advanced imaging services that are furnished in an applicable setting, such as office or outpatient, and paid under an applicable payment system, such as MPFS or OPPS. However, in the 2017 Final Rule CMS designated eight “priority clinical areas” that will be the focus for identifying outliers:

  • Coronary artery disease (suspected or diagnosed)
  • Suspected pulmonary embolism
  • Headache (traumatic and non-traumatic)
  • Hip pain
  • Low back pain
  • Shoulder pain (to include suspected rotator cuff injury)
  • Cancer of the lung (primary or metastatic, suspected or diagnosed)
  • Cervical or neck pain

Moderate Sedation

CMS is decreasing the RVUs of codes that previously included moderate sedation, which will now be separately reportable with all procedures including those that were previously listed in Appendix G of the CPT® manual. For example, interventional radiologists who provide moderate sedation in conjunction with lower extremity revascularization or percutaneous biliary procedures should report the sedation service separately beginning on Jan. 1, 2017 using new sedation codes 99151-99157. Note that CMS has also created an HCPCS code (G0500) for moderate sedation, but this code is used only in conjunction with GI endoscopy.

Preliminary Comparative Analysis

We have performed a preliminary comparative analysis of 2017 versus 2016 with the “Imaging Cap” (lower of OPPS or MPFS) for all affected technical component CPT codes. There have been rumors in the marketplace that some MRI codes experienced cuts up to 58 percent in 2017 versus 2016. We do not see such drastic cuts in our preliminary analysis, but we do see certain MRI, CT and Ultrasound codes with reductions in the technical component from as low as .8 percent to as high as 19 percent (selected MRI codes). We also see some slight increases in technical component rates as well.

When a more complete analysis has been performed, IRP will publish the results. The full impact of the changes in the 2017 MPFS to practices will only be fully understood based upon their historical utilization volume by modality, by CPT code. It will also be important to factor in any changes to practices’ locality Geographic Practice Cost Index (GPCI).

To learn more about the 2017 MPFS Final Rule’s impact on radiology and other medical specialties, please contact us.

Medicare Physician Fee Schedule Final Rule:
Impact on Radiology, Part I

By Douglas G. Smith, FRBMA, Managing Partner of Strategic Positioning & Consulting Solutions


Last month, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, which updates policies and payment rates for services provided on or after Jan. 1, 2017. CMS released the Proposed Rule for comment on July 7, 2016.

Overall, CMS estimates a 2017 conversion factor of $35.8887, a slight increase from the current conversion factor of $35.8043. This change reflects the .5 percent update included in the Medicare Access and CHIP Reauthorization Act of 2015, and will result in an estimated one percent decrease in radiology and interventional radiology payments. Radiation oncology and nuclear medicine payments will remain unchanged.

While this is an improvement from the proposed seven percent reduction in interventional radiology payments, starting in January, certain interventional radiology codes will be bundled, reducing reimbursement for some procedures. For example, cerebral arteriograms are currently reported with component codes, allowing doctors to receive payment for each vessel studied. Instead, procedures performed in 2017 will be reported wholesale, probably resulting in a lowered payment for half of the codes.

The Final Rule also confirmed that any relative value unit (RVU) reductions greater than 20 percent will be phased in annually; therefore, a code faced with a 50 percent RVU reduction would be limited to a decrease of 19 percent in total RVUs each year.

Below are additional changes and announcements from the Final Rule: 

New Bundled Mammography Codes
Starting in January 2018, codes for digital, film screen and computer-aided detection (CAD) mammography will be bundled into one set of three mammography codes. In 2017, CMS will continue using existing G-codes (G0202, G0204 and G0206). CMS will also not make any changes to the technical component (TC) reimbursement for mammography with CAD.

Practice Expense Inputs for Digital Imaging Services
CMS will price the professional PACS workstation at $14,616.93, and has provided a list of 426 radiology codes to which the professional PACS workstation will be added. They have also requested comment on additional codes. This change should result in a bump in TC.

Reimbursement Reductions for Plain Film X-rays
Reimbursement for X-rays taken with plain film will be reduced by 20 percent in 2017 and all subsequent years. In addition, reimbursement for computed radiography will be reduced by seven percent between 2018 and 2022, followed by a 10 percent reduction in 2023 and all subsequent years. To implement the plain film X-ray reduction, CMS has established a new modifier (modifier “FX”) to be used on applicable claims.

CMS has demonstrated over the past two years its commitment to getting digital images into the EMR. While some entities may choose to take a hit in 2017 rather than make the capital investment in digital radiology, the penalties in the coming years may warrant the investment.

Delayed CDS/AUC Implementation
CMS has delayed the implementation of the clinical decision support (CDS)/appropriate use criteria (AUC) program to Jan. 1, 2018 as policymakers continue to debate what CDS vendors will qualify as CDS solutions as well as the role radiology will have in the CDS process. CDS implementation will apply to orders for all advanced diagnostic imaging services, not just priority clinical areas.

The final list of priority clinical areas includes coronary artery disease (suspected or diagnosed), suspected pulmonary embolism, headache (traumatic and non-traumatic), hip pain, low back pain, shoulder pain (to include suspected rotator cuff injury), cancer of the lung (primary or metastatic, suspected or diagnosed), and cervical or neck pain.

CMS also finalized the requirements for the CDS/AUC reporting delivery mechanism. CMS will begin to accept the first applications for CDSMs immediately, with an application deadline of March 1, 2017. The qualified CDSMs will be announced by June 30, 2017.

Moderate Sedation
Medicare frequently pays for anesthesia services provided by an anesthesiologist or CRNA in conjunction with procedures that are defined as including moderate sedation. In order to eliminate this double payment, CMS is decreasing the RVUs of codes that previously included moderate sedation, and moderate sedation will now be separately reportable with all procedures, including those that were previously listed in Appendix G of the CPT® manual. For example, interventional radiologists who provide moderate sedation in conjunction with lower extremity revascularization or percutaneous biliary procedures should report the sedation service separately beginning on Jan. 1, 2017, using new sedation codes 99151-99157. Note that CMS has also created a HCPCS code (G0500) for moderate sedation, but this code is used only in conjunction with GI endoscopy.

Preliminary Comparative Analysis
We have performed a preliminary comparative analysis of 2017 versus 2016 with the “Imaging Cap” (lower of OPPS or MPFS) for all effected Technical Component CPT Codes. When a more complete analysis has been performed, IMP will update our blog with the results.

Overall, the Final Rule presents several benefits to the specialty of radiology. In addition to phased-in RVU reductions and the delay in CDS implementation, the rule upholds the mandate to lower the existing professional component multiple procedure payment reduction (PC MPPR) from 25 percent to five percent effective Jan. 1, 2017.

To learn more about the 2017 MPFS Final Rule’s impact on radiology and other medical specialties, please contact us.

A Better Radiology Partner: The Collaborative Approach

A Better Radiology Partner: The Collaborative Approach

By Integrated Radiology Partners.

November 07, 2016

IRP’s white paper, “A Better Radiology Partner: The Collaborative Approach” outlines the benefits of the collaboration model for hospital and health system leaders seeking to thrive in today’s highly competitive landscape. This proven model allows healthcare executives the ability to increase subspecialty access, cut costs and invest in forward-learning technology designed to improve quality through increased interoperability across the continuum of care.

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Using Analytics to Reduce Unspecified Diagnoses

By Cheryl Loper-Fimreite, Vice President of Coding & Compliance

While most physician practices and health systems implemented ICD-10 with only minor snares along the way, some groups did report a decline in productivity as coders rushed to become familiar with the new code set. Fortunately, the specialty of radiology only uses about 4 percent of the 68,000 codes within the ICD-10 set, significantly narrowing the learning curve for radiologists and radiology-focused coders.

The year-long grace period offered by the Centers for Medicare & Medicaid Services (CMS) served as another aid in the transition. For many payers, the use of unspecified ICD-10 diagnosis codes would lead to many claim denials for failing to meet medical necessity or the payer’s specific policy for the procedure performed. For this reason, CMS gave physicians and coders one year to become familiar with the new ICD-10 coding set and the greater level of specificity it required.

As of Oct. 1, 2016, however, that grace period came to a close. If there is an established policy in place (Medicare National Coverage Determinations (NCD) or Local Coverage Determinations (LCD)), Medicare may now deny certain unspecified diagnoses. If other payers offered a similar grace period, they also may follow suit and deny these claims.

To mitigate the impact this change may have on practice revenue and coder productivity, it is critical to develop and implement an advanced analytics platform to track and cut down on unspecified codes. Many industry leaders have already realized the potential of analytics to generate positive changes in healthcare: In a 2012 executive report titled “The value of analytics in healthcare,” the IBM Institute for Business Value states: “Using analytics to gain better insights can help demonstrate value and achieve better outcomes, such as new treatments and technologies. Information leading to insight can help informed and educated consumers become more accountable for their own health. Analytics can improve effectiveness and efficiency.”

Analytics can help to significantly reduce the number of unspecified diagnoses and therefore protect practices’ cash flow. Radiology groups should aim for unspecified codes to account for less than 10 percent of gross charges, keeping in mind there are times when radiologists do not have additional information regarding the patient’s condition or medical history, and that there are a few unspecified ICD-10 diagnoses that do not provide a more specific diagnosis option.

Achieve a 360-degree practice view
An advanced analytics platform that can leverage both structured and unstructured data can help physician practices better prepare for life in a post-grace period world. Because between 60 and 70 percent of all radiology exams are normal, it is critical for radiologists to obtain full clinical history to optimize the quality of care and minimize the use of unspecified codes.

Analytics are able to filter data by provider, modality, payer, location, place of service and referring provider, granting physician leaders and administrators a 360-degree view of their coding performance. These types of platforms can also help highlight areas of improvement down the line.

Gain recommendations to reduce unspecified codes
Analytics platforms can also sort the top 10 or 25 unspecified ICD-10 codes used by practices and make helpful recommendations to improve dictation and coding while reducing denials. These unspecified diagnoses are often missing anatomical- or morbidity-related information, such as laterality, body location and severity.

For example, the I65.29 code for occlusion and stenosis of unspecified carotid artery merely requires providers to document the affected carotid arteries (right, left or bilateral). By adding this piece of information, physicians can reduce claim denials and help drive uninterrupted cash flow.

While ICD-10 did not cause the turmoil many industry leaders anticipated, it did increase the workload of physicians and coders alike. To learn more about the power of analytics to reduce unspecified ICD-10 codes and increase practice and coder productivity, please email us at


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

The Collaboration Model: An Emerging Solution For Radiology Groups

By Keith Chew, MHA, CMPE, FRBMA, Senior Vice President

As the healthcare industry continues to see widespread consolidation in the forms of mergers, acquisitions, joint ventures and collaborations, it has become imperative for hospital-based radiology groups and outpatient imaging centers to consider their strategy for future growth in their market.

Between 2010 and 2013, the American College of Radiology (ACR) Commission on Human Resources’ annual workforce survey reported a 10 percent decrease in the number of U.S. radiology groups. In an interview with Radiology Today, the commission’s chairman, Edward Bluth, M.D., attributed part of this decrease to consolidation and part to radiologists leaving private practice to join a hospital or health system.

As radiologists combine or become acquired by larger industry players, it is crucial to consider the best path moving forward in this highly competitive landscape. Several business models have emerged over the past decade for practices and imaging centers to choose from, including large group networks, acquisition by management company and regional collaboration among noncompetitive groups.

Below are further details regarding these three models for radiology groups and imaging centers to consider as they plan for future growth and success:

Large group network
Large practice consolidation has become increasingly popular in the specialty of radiology. One example of this model is Strategic Radiology, a network of 1,300 radiologists across the United States with shared access to data, clinical information and certain economies of scale.

Although these types of networks aim to connect radiologists to provide high-quality, cost-effective care, they focus on larger groups with a minimum of 50 providers while looking to smaller, regional players only in affiliate status roles. It is a relatively exclusive model built to further bolster large radiology practices, simply selling services to smaller groups with fewer than 50 providers who offer local services on a smaller scale. 

Management company acquisition
Over the past decade, single- and multi-specialty management companies have steadily acquired more and more physician practices, promising providers fewer administrative headaches and greater economies of scale. A report by consulting firm PricewaterhouseCoopers (PwC) titled “Q1 2015 U.S. health services deals insights” demonstrated how this trend shows no sign of slowing down; in fact, the volume of deals increased from 13 in Q1 2014 to 21 in Q1 2015, with 18 of the 21 deals announced involving physician practice management companies such as MEDNAX and IPC The Hospitalists Company.

While multi-specialty companies begin to add radiology to their service lines, such as MEDNAX’s acquisition of vRad in May 2015, single-specialty management companies such as Radiology Partners (RadPartners) continue to expand their network size through a traditional M&A model. Though RadPartners positions itself as “partnering” with radiology groups, it primarily acquires groups then promises health systems greater stability, while essentially removing or diluting radiology practices of their clinical and operational autonomy.

And while this may appear an attractive option for radiology groups seeking a partner to manage daily operations in an increasingly complex landscape, integrating into the management company often brings a host of challenges regarding workplace culture and the managing of expectations on both sides of the transaction.

Regional collaboration among likeminded groups
The emerging alternative to the two aforementioned models is a more collaborative approach, a true partnership between likeminded, noncompetitive radiology groups to pool resources and expand subspecialty access while remaining clinically and operationally autonomous.

Built to support sustained independence and growth in a dynamic market, the collaborative model provides groups the tools they need to survive and thrive in the age of value-based care by transforming practices and centers into more nimble organizations. This model can better help radiology groups prepare for a future of enterprise imaging designed to provide a unified patient view, equip them with economies of scale to offer greater purchasing power, and provide a more advanced analytics platform to collect the necessary metrics to accurately evaluate practice performance. For an overview of the benefits of this emerging model, please click here.

It has become critical for radiology groups and imaging centers to consider these emerging business models and determine which will best prepare them for future growth and long-term success without sacrificing their clinical independence. To learn more about the collaboration model and IRP’s suite of practice solutions, please contact us at

Integrated Radiology Partners Announces Mid-Year Collaborative Partnerships

Radiology groups secure their future with IRP’s comprehensive practice solutions

Milwaukee, Sept. 1, 2016 — Integrated Radiology Partners (IRP) announced today their mid-year partnerships among likeminded radiology groups across the country. By coming together as collaboratives, practices receive the clinical and business resources they need to achieve superior performance and remain independent. IRP’s mission is to provide an innovative collaboration model to offer groups access to technology, operational scale and additional resources necessary to secure long-term growth and clinical autonomy in an increasingly competitive market.

New partnerships include:

  • Cambria Somerset/Life Point Hospital System (Radiology, support provided through IRP) 
  • Empire Health Support Services (Radiology, support provided through IRP)
  • Synergy Health Alliance (Radiology, support provided through IRP)

IRP is a leader in fostering independent radiology group collaboration. It delivers a full suite of tightly integrated practice management and business intelligence solutions tailored specifically for radiology practices, outpatient imaging centers, and other radiology providers and enterprises which are valuable members of the care continuum.

“We are thrilled to work with each partnership and excited to bring together the expertise, leadership and resources necessary to deliver the most comprehensive practice management solutions in the industry,” said Bill Pickart, CEO of Integrated Medical Partners (IMP). “The collaborations announced today demonstrate IRP’s continued commitment to growth and our proven track record of fostering long-term success for visionary radiology practices.”

About Integrated Radiology Partners, LLC
Integrated Radiology Partners (IRP) is The IMP Solution for Radiology Practices. IRP is the proven leader in fostering independent radiology group collaboration and facilitating superior practice performance. Through IRP’s collaboration solution and leveraging a fully integrated suite of practice management tools, radiology groups gain the necessary business and clinical intelligence as well as requisite workflow management resources to position themselves for continued growth and success in their markets.

For more information, visit

Media Contact

Sandra Pickart

Collaboration 101: The changing competitive landscape

By Keith Chew, MHA, CMPE, FRBMA, Senior Vice President

Consolidation is finally coming to healthcare.

After decades of fragmentation, financial pressures, heightened competition and regulatory changes are contributing to an increase in mergers and acquisitions across the spectrum of healthcare stakeholders – payers, health systems, physicians groups and more. According to the 2014 Deloitte Center for Health Solutions study “The Great Consolidation,” the average deal size for hospital acquisitions increased from $42 million in 2007 to $224 million in 2013. Using three separate approaches, Deloitte’s research team found that, by all three estimates, only 50 percent of all current U.S. health systems will remain in 10 years.

While this may be an alarming statistic for radiology practices and imaging centers to digest, a solution has emerged in recent years to combat this trend and keep medicine local. Collaboration among likeminded, noncompetitive physician groups has provided an attractive alternative to the recent increase in M&A activity. The collaborative model provides radiology groups the opportunity to work together to achieve some of the benefits of larger industry players, while keeping medicine local and maintaining a strong connection with the community in which they serve.

The following are five key benefits of this emerging model:

Increased subspecialty access
Increased access to subspecialists has become a critical factor in the survival of radiology groups and the quality of care they provide. According to the American College of Radiology (ACR), radiologists have an average error rate of nearly 30 percent, with 70 percent of the errors due to an unperceived, or “missed,” abnormality in the reading.

By joining a collaborative, radiology groups can expand their capability to serve their patient population by becoming interconnected remotely with subspecialists throughout their community, state or even region. This can produce better clinical decisions, increased patient safety and improved patient care through improved contribution by radiology to patient care diagnostics.

Medical malpractice cost-savings
While an increased number of providers tends to lower medical malpractice costs, there is a ceiling associated with how large a practice can become, preventing future cost-savings. By combining a larger provider pool with a powerful analytics platform, collaboratives can build a customized medical malpractice program based on the group’s documented, detailed performance. By tracking key metrics like the number of incidents and the number of misdiagnoses, radiology groups can begin to better understand their risk profile and create a custom risk management program designed to lower costs and improve the quality of care they provide.

Advanced analytics capabilities
The healthcare industry is gradually understanding the potential power of analytics to improve results and enhance operational and clinical efficiencies. According to a 2015 survey from the Deloitte Center for Health Solutions, more than half of the health systems surveyed identified population health analytics as the top investment focus moving into 2016, and more than three in five reported they will invest in advanced analytics capabilities for clinical and population health functions.

By collaborating with likeminded groups, radiologists can adopt an advanced analytics platform that can leverage structured and unstructured data to track key metrics and improve practice performance. To learn more about the capabilities of analytics, please download our white paper here.

Enterprise imaging technology
For the past three decades, healthcare has been increasingly focused on interoperability and the pursuit of a comprehensive, unified patient view. Radiology has been at the forefront of this movement, beginning with the development of Digital Imaging and Communications in Medicine (DICOM) in the early 1990s.

As patient coverage expands and the quality of care improves, the full transition toward interoperability in healthcare hinges in part on the success of enterprise-wide imaging, a movement to eliminate inefficient silos in radiology and, ultimately, develop a unified patient view that gives the clinician access to everything he/she needs to provide high quality care in a timely fashion. Through a collaborative model, groups can begin to adopt cloud-based technologies that bridge these silos of data, increase efficiency and improve patient care and regulatory compliance.

Economies of scale
As reimbursements continue to decline and the industry continues its shift from fee-for-service to payment-for-value models, it is increasingly important for radiology practices and imaging centers to reduce costs and improve productivity to create a leaner organization.

Membership in a group collaborative provides radiologists the opportunity to achieve economies of scale for their practice while maintaining clinical autonomy. By improving purchasing power and pooling resources, radiology groups can better prepare for the future of healthcare and secure their independence despite increased competition.

Collaboration among likeminded radiology groups has emerged as an attractive alternative for radiology groups seeking to remain independent in an increasingly consolidated market. To learn more about this business model and its varied benefits, please contact us at

Why Satisfaction Surveys are Vital

By J. Brian Bruce, Vice President of Business Development

The era of value-based healthcare is (almost) here.

The Centers for Medicare and Medicaid Services (CMS) recently proposed a new program that would further shift the nation’s healthcare system away from the fee-for-service payment model, and more towards value-based care. The proposed Quality Payment Program (QPP) is part of the agency’s implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the bipartisan “doc fix” and children’s healthcare extension that became law in 2015.

QPP would create a “unified framework” for transitioning the national insurance program for seniors towards outcomes-based payments, according to CMS. The proposed payment program will include two payment pathways: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). These would replace “a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.”

Under the proposal, a provider’s MIPS score initially will be comprised of four parts: cost (10 percent), quality (50 percent), clinical practice improvement activities (15 percent) and advancing care information (25 percent). The MIPS score will then be used to determine if a provider is reimbursed more than, less than or at the standard Medicare rate. In addition, certain providers will be eligible for an exemption from the MIPS system by participating in APMs—specialty incentive payment models proposed under QPP.

The public comment period for QPP ended June 27, 2016.

Of course, performance-based reimbursement is not an entirely new concept in healthcare. Today, most groups’ reimbursement is based on its Clinical Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey score. Conducted annually, this survey attempts to measure patient satisfaction based on a variety of healthcare experiences, such as communication with medical providers or pain management after a procedure is complete.

As a result, successful practices are taking their own snapshots of patient satisfaction and other operational and clinical factors. Proactively measuring ongoing performance allows physician leaders to make the necessary adjustments before reimbursements are affected and a group’s bottom line suffers—an activity that inevitably will become more important in the coming era of value-based care.

Conduct internal surveys
Sensing a growing need for more accurate and efficient practice information regarding patient satisfaction, valuable tools like Survey Vitals help physician groups better assess their performance. Conducting internal surveys independent of those required by the federal government provides practices with the opportunity to better understand the intricacies of the satisfaction metric.

For example, the CG-CAHPS survey delivers information based on the last three to six months; as a result, practices may not know about an internal issue or weakness until it has been happening for 180 days. Tools like Survey Vitals have 24-hour turnaround times, providing real-time data to practices at an affordable cost. In addition, these tools can be catered to specific medical specialties, offering relevant feedback that providers can immediately act upon to reduce errors and operational inefficiencies while improving patient satisfaction.

Generate actionable reports
In an era of increased pressure to lower costs and expand productivity, physician groups that show a proactive interest in adding value to the organization are especially attractive to hospitals and health systems.

While CG-CAHPS and Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) surveys may provide skewed, old or irrelevant information, physician groups can use specially designed electronic surveys to generate actionable reports that detail strengths and weaknesses. And presenting these reports to hospital leaders and tracking progress over time shows initiative in an increasingly competitive healthcare landscape.

Leverage data
Equipped with detailed patient satisfaction data, physician leaders must use this information to move their practices in the right direction. Identifying areas for improvement and appropriately addressing deficiencies to increase satisfaction survey scores is the critical final step in improving patient outcomes and overall satisfaction. As survey scores continue to further affect reimbursement, groups must leverage their data to make better-informed decisions regarding clinical care, operational efficiencies and practice performance.

According to CMS, hospitals could stand to lose or gain 2 percent of reimbursement dollars by 2017, depending on their H-CAHPS scores. For a typical hospital, that could put as much as $850,000 at risk annually. There is an upside. Under proposed changes, a hospital with $120 million in annual revenues could also receive as much as $5.4 million in additional incentive payments, according to a report by Press Ganey.

In healthcare, measuring performance is no longer optional. It is vital for success in today’s competitive market. As a result, patient satisfaction surveys provide physician leaders with a real-time snapshot of a practice’s performance, allowing the necessary adjustments to be made to ensure optimized cash flow.

To learn more about administering satisfaction surveys, please contact us at