Why MACRA metrics are unsuited for radiology

Seattle Mariners pitching ace Felix Hernandez represents medical imaging. No, really, just hear me out. The 2010 Cy Young award winner was eclipsed by Tampa Bay’s David Price in winning percentage during the 2010 season, but led the league in pitching-specific statistics like earned run average and strikeouts. While winning is usually the end all be all in sports, specific metrics were in Hernandez’ favor, so he took home the award for the top pitcher in the American League. 

“Just as the win/loss ratio provides limited information on a pitcher’s success, the best way to evaluate radiology performance is not necessarily the patient outcome, but rather the specific performance of the practice or department,” wrote Richard E. Heller III, MD, in an article published in the Journal of the American College of Radiology.

A medical team works together towards its goal of providing the best care possible, just as a baseball team works to defeat the opposing team. The pitcher represents medical imaging: central to a positive outcome, highly specialized and somewhat isolated.

Radiologists contribute to the team in very specific ways. Imaging directly impacts patient outcomes, such as decreased mortality across a population that undergoes cancer screening. It can also reduce overall costs, for example, by demonstrating that an expensive surgery is not necessary. These factors combine to form imaging’s third impact: It can reduce the length of an episode of care. However, current metrics are not designed with these unique facets of radiology in mind.  

This issue will only grow as the industry moves from volume to value. The Alternate Payment Models (APMs) introduced by the Medicare Access and CHIP Reauthorization ACT (MACRA) reforms emphasize patient outcome to determine reimbursement, which can handcuff radiologists.

“This can be a challenge for measuring and grading performance in radiology, which is often several steps removed from patient outcome,” wrote Heller.

In addition, a lack of standardized quality measures has created an overabundance of metrics, meaning that those ties to reimbursement are “arbitrary and ineffectual.” Instead, designing focused, uniform, and radiology-specific metrics can give radiology a pathway to fulfilling MACRA performance goals.

“Radiology metrics should reflect the unique position of radiology in the value chain of patient care,” wrote Heller. “Ideally, performance-based reimbursement measures in health care are limited in number, are realistically measureable, impact patient outcome (including cost considerations) and are under the control of the group being incentivized.”