Radiology-specific alternative payment model in the works to counter ‘devastating decline’ in reimbursement
RBMA is eyeing the creation of a new radiology-specific alternative payment model to help counter flagging reimbursement rates in the specialty.
The association’s board of directors recently approved a proposal to begin designing the new pay approach. Those involved hope to establish incentive payments for physicians to drive value in imaging, generate savings for Medicare, reduce waste and bolster the quality of care.
“For the past 15 years, radiology has experienced a devastating decline in reimbursements under the Medicare Physician Fee Schedule,” the Radiology Business Management Association said in an April 18 announcement following its annual meeting in Hollywood, Florida. “RBMA’s board action reflects its organizational belief that now is the time to begin discussions with Congress and the Centers for Medicare and Medicaid Services regarding a new model for physician payments.”
Lawmakers have recognized the benefit of such payment models, the American Medical Association noted recently. As part of the Medicare Access and CHIP Reauthorization Act, or MACRA, Congress authorized 5% annual lump sum payments to physicians taking part in alternative payment models at a certain threshold. MACRA also spells out a process for physicians, practices and specialty societies such as RBMA to develop “physician-focused payment models” for consideration in Medicare.
Medical doctors have responded, submitting more than 30 proposals to the relevant CMS advisory committee. Those include one developed by the American College of Emergency Physicians and approved by Medicare advisors, which would incentivize ED providers to send certain patients home to avoid costly and unnecessary admissions. Societies representing surgeons and internal medicine specialists also have developed their own APMs, which the American Medical Association said it supports.
“The ACR is following the development of advanced APMs and continues to track how radiology may fit into such models,” the American College of Radiology said on its own webpage dedicated to the topic.
RBMA emphasized that any new payment model would be voluntary, asking physicians to enroll for a certain number of years. The APM would establish benchmarks, asking radiologists to take on risk but also presenting the possible reward of generating shared savings for the specialty. One potential quality metric could include measuring whether radiologists are adhering to appropriate use criteria, according to the announcement.
Association leaders and RBMA’s grassroots advocacy network are now devising details about the possible APM in the hope of meeting with key members of Congress sometime in 2023.
“A radiology-specific APM is an important step in ensuring that high-performing practices receive reimbursement reflective of the value they provide Medicare beneficiaries,” RBMA President Kit Crancer said in the announcement. “I’m looking forward to working with organizations across the country to develop and offer new, innovative approaches to improving patient outcomes.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.