Radiology business leaders urge Congress to replace ‘burdensome’ Medicare payment program

The Radiology Business Management Association is urging congressional leaders to replace a “complex and burdensome” federal payment program that was supposed to improve care quality. 

Last month, the Republican and Democratic Doctors Caucuses sent an informal request to medical societies, seeking ways to reform Medicare’s push toward value-based care. Passed in 2015 by Congress, the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, was supposed to reward radiologists and other docs for delivering quality care.

However, RBMA and others contend its key Medicare's Merit-based Incentive Payment System, or MIPS, has morphed into a “pay for reporting” program that’s only overworking docs.

“Bottom line: MIPS was designed to reward quality and efficiency, but its structure often amplifies disparities, has high compliance costs with minimal financial benefit, is complex and burdensome, and is subject to bias and manipulation,” RBMA President Jamie Dyer, MBA, also chief outpatient operations officer of Central Oregon Radiology Associates, and colleagues wrote to the Doctors Caucus on Jan. 15. “MIPS fatigue is real and can contribute to clinician burnout.”

RBMA noted that radiologists’ ability to participate in these payment models has been limited thus far. That’s because the specialty often does not consult directly with patients, nor is it able to control imaging utilization. Future such Medicare models should strive to ensure that all clinical specialties have equal opportunity for input and participation. One of the guiding bodies under MACRA, the Physician Focused Payment Model Technical Advisory Committee, currently has no radiologists as members. 

The association also highlighted other challenges with MIPS, including a disproportionate burden falling on small and rural practices, which lack staff and technology to handle complex reporting requirements. Same for safety-net providers, who treat smaller volumes of patients, with a higher reliance on Medicaid rather than Medicare. 

“RBMA recommends that CMS focus on specific programs that are manageable, will increase quality while reducing costs, and allow all providers to participate equally, and remain unchanged long enough to afford providers the time needed to drive quality improvements,” Dyer and colleagues wrote. 

The association gave three possible examples, with potential programs focused on appropriate use criteria for ordering imaging exams, incidental findings follow-up, or participation in national health information exchanges. As another option, RBMA also highlighted the American Medical Association’s proposed replacement for MIPS. Dubbed the Data Driven Performance Payment System, or DPPS, the program would cap payment penalties for missing targets, ease IT requirements, and replace broad cost metrics. 

DPPS has the potential to benefit radiology and other specialties that struggle under the Medicare's Merit-based Incentive Payment System, Dyer and colleagues contend. That’s because it would reduce the administrative burden, provide more stable payment updates, enact measures that better reflect radiology and other specialties, and support small practices. 

“Radiology plays a foundational role in modern medicine, yet current CMS models and MIPS structures have failed to recognize our unique position as consultants rather than drivers of utilization,” the letter writers note. “We urge policymakers to adopt these recommendations and ensure that all specialties, including radiology, have a voice in shaping models that deliver real value for patients and providers alike,” they added later. 

Several others also recently weighed in on the Doctors Caucus request for information. Others submitting responses have included the American College of Radiology, AAMC, American Hospital Association, Society of Hospital Medicine, and the Alliance of Specialty Medicine (which includes the Society of Interventional Radiology).