Radiologists urge specialty to ‘speak up’ on reimbursement-related issues
CHICAGO — Radiologists are urging members of the specialty to “speak up” on issues that impact their pocketbooks.
Three radiologists presented on hot topics in imaging economics Sunday during the opening day of RSNA 2025 in Chicago. Richard Heller, MD, MBA, highlighted two pressing payment issues warranting radiologists’ attention: Medicare’s recently finalized “efficiency adjustment” and Anthem’s newly announced out-of-network restrictions.
On the latter, the commercial payer is planning to levy a 10% fee on hospitals that use radiologists and other physicians who are outside of its networks beginning Jan. 1. Heller noted the No Surprises Act already was established years ago to settle such disputes, with Anthem trying to bully physicians to produce its desired outcome.
“Providers win generally 80% or more of these arbitration disputes, and that helps explain why they're doing this,” Heller, who is senior VP of public policy for Radiology Partners, told attendees Nov. 30. “They're trying to force physician practices to go in-network with them to avoid going through the [No Surprises Act] process. But this problem they're trying to solve, what they're doing actually creates more problems.”
He highlighted the “operational complexity” of hospitals trying to determine which of their numerous physician practice partners are in-network with Anthem. Often a doc group might have a dozen or more different contracts with numerous payers.
“Now you're going to try to keep track of all these hundreds of different contracts? It's a logistical nightmare for the hospitals,” Heller said. “It can threaten access to quality care. For one thing, it actually puts who you contract with as one of the top issues when credentialing should be really about: Are you qualified to provide services in the hospital?”
Heller—whose organization is the No. 1 initiator of No Surprises Act disputes, according to CMS data—also worries Anthem’s policy could lead to further consolidation in healthcare. Hospitals may seek to acquire physician practices, rather than facing a penalty for using out-of-network docs.
“So, what do I think Anthem should have done? I think they should have gone to the physician practices and tried to contract reasonably,” he told attendees. “Clearly, physician practices want to be in-network with payers at reasonable, sustainable rates. Going through that arbitration process is lengthy, it's expensive and it's unreliable. We would much rather be in-network at reasonable sustainable rates. But instead, what Anthem did was go to the hospital to try to pressure physician practices to accept contracts that are not reasonable or not sustainable.”
Heller and others spoke as part of a panel discussion introducing radiologists to economic issues and underlining the importance of advocacy. He also highlighted a recent letter-writing campaign from the American College of Radiology and other physician societies, urging Anthem to rescind its policy. Heller believes advocacy is one of the best ways for radiologists to speak out on economic issues. He highlighted one of the specialty’s recent such victories, with CMS agreeing to permanently allow virtual supervision of contrast administration.
“These wins don't just happen,” he told attendees. “They happen because we as physicians show up. Most members of Congress are businesspeople and lawyers. Few have backgrounds in healthcare, less are physicians, none are radiologists. And that's why it's so incredibly important that we, the people in this room, the community of radiologists, speak up and make our voices heard for our specialty, for our practices, and most importantly for the patients in our care.”
How to get involved
Radiologist Lauren P. Nicola, MD, CEO of Triad Radiology Associates, followed by suggesting potential ways in which members of the specialty can get involved. She cited four reasons why “speaking up matters.” (1) Economics is how radiology can remain accessible and sustainable. (2) Silence on these issues leaves the decisions to be made by other nonradiologists. (3) It’s crucial to educate others on what the specialty does, and (4) advocacy can help spur individual career growth.
On the latter, Nicola recalled how she took on a less-than-ideal role with late-night hours at her Winston Salem, North Carolina, practice over 10 years ago amid a bad job market. However, her interest in policy issues and knowledge on the Merit-based Incentive Payment System help to make Nicola “indispensable” to the organization, eventually helping propel her into a leadership role. She encouraged radiologists to get involved in advocacy across three potential spheres, starting at the practice level and ascending to national-stage discussions.
Some examples of practice level involvement could include:
- Understanding revenue cycles, payer mix and productivity metrics.
- Making educated decisions on technology investments, artificial intelligence strategy and clinic workflows.
- Succeeding in pay-for-performance and value-based care models.
- Developing innovative compensation structures in modern practice.
- Aiding in negotiations with payers and hospitals.
Some examples of state level advocacy efforts include:
- Joining state chapters of the American College of Radiology (Nicola also is a member of the ACR Board of Chancellors).
- Conducting legislative visits and other grassroots activities with local lawmakers.
- Talking to payers and trying to figure out how to get imaging services covered in the region.
- Using state societies as an “on ramp” to build toward leadership roles.
Meanwhile, involvement at the national level could include joining the ACR’s Economics Commission or various other legislative bodies, the RSNA’s econ-related committee, other specific subspecialty societies or the American Medical Association. Radiologist and AI expert Nina E. Kottler, MD, MS, also spoke during the session, encouraging rads to take part in the AMA and ACR payment initiatives to encourage insurers to cover new and emerging AI tools.
“The truth, of course, is that all three spheres are interrelated,” Nicola told attendees. “The practice level, the state level and the local level—they’re not separate and they’re not even really sequential. Often, when you’re doing one, you’re doing another in tandem.”
Nicola suggested four potential ways in which radiologists can start getting more involved in payment issues. These can include learning the language of economics, looking for problems locally or within the practice that need to be solved, joining societies, and helping “drive long-term strategic decisions.”
“Find ways to make yourself indispensable in ways that align with your passion,” she told attendees.
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.