Radiology policy shifts threaten patient access and physician sustainability
Richard Heller, MD, MBA, senior VP of health policy at Radiology Partners, recently outlined several mounting policy pressures radiology faces heading into 2026.
During a session at RSNA 2025, Heller focused on the importance of physician-led advocacy and included perspectives on engagement, policymaking, and AI reimbursement. Two key takeaways he highlighted in an interview with Radiology Business were the new Medicare physician efficiency payment reduction and policies by Anthem insurance he said fly in the face of the No Surprises Act and good-faith negotiations with physicians.
CMS efficiency cuts draw strong pushback
Among the most pressing concerns are cuts baked into the 2025 Medicare Physician Fee Schedule, with the Centers for Medicare and Medicaid Services (CMS) reducing work RVUs for non–time-based services. Heller said this essentially includes most imaging studies on the assumption that radiologists will become more efficient reading studies over time. CMS will begin reducing work RVUs by 2.5% starting Jan. 1 for most radiology exams. But Heller emphasized this logic does not reflect modern imaging complexity.
“What CMS has said is that for non-time-based services, over time you should be getting more efficient at reading radiology exams so it should take you less time," explained Heller, who also is a longtime advocate with the American College of Radiology and RSNA. “Their idea that radiology exams are generally static shows they don't necessarily understand what it is that we do. And their idea that technology is always making you faster is also not necessarily true.”
While technologies like PACS improved efficiency, advances such as multidetector CT have increased the number of images from 40-50 per exam to over 1,000. The same is true with 3D mammograms greatly increasing the number of images that need to be read. The need to also look at multiple reconstructions of CT and MRI images also has significantly increased radiologists' workloads.
“These technologies are improving the level of care that we as radiologists provide, but they're not necessarily taking us less time to do,” Heller said.
The long-term concern is that CMS intends to reevaluate and potentially repeat these reductions in future years. Heller said the agency will start in 2026 and review further decreases in pay every few years.
The ACR has formally challenged the proposal, submitting a comment letter to CMS, he added.
Anthem policy may limit access to imaging
Heller also spotlighted a new Anthem policy that could reshape hospital-based radiology nationwide. Beginning Jan. 1, the insurer will reduce payments to hospitals that contract with radiology groups that are not in-network with Anthem across 11 states. Continued use of those radiologists could even threaten a hospital’s network status.
“What Anthem has said to the hospital is, 'If you use these radiologists for our patients, we are going to penalize financially you the hospital. And if you keep doing it, we might kick you out of our network,'” Heller said.
This could harm patient access at these hospitals.
“The reason they're doing it is they're trying to pressure the hospitals to then pressure the radiology practices to go in network with Anthem, presumably for terms that are not sustainable for the practice,” he said.
Heller emphasized that radiology groups want to be in-network, but at fair, sustainable rates.
“You don't want to have to go through the arbitration process and the No Surprises Act. It is far better from the physician practice perspective to be in network,” he explained.
Anthem circumventing No Surprises Act's intentions
Heller believes Anthem’s policies appear to be circumventing the intent of the No Surprises Act. He noted that the NSA shields patients from unexpected out-of-network bills, while providing an arbitration mechanism when physicians believe reimbursement is inadequate. Insurers, however, have increasingly tried to use contracting pressure or arbitration strategies to drive rates down.
“This policy is an attempt to do an end-around the No Surprises Act … the patients are protected. And I think the frustration is there's already a mechanism in place to protect patients,” he said. A broad coalition of medical societies has already pushed back.
“There was a multispecialty letter that was written to Anthem, signed by over 50 specialty societies and over 30 state medical societies, which simply encouraged them that instead of trying policies like this, have good faith network contract negotiations,” Heller said.
Advocacy for fair radiology policy remains central
The RSNA session underscored that radiologists must remain deeply engaged in shaping policy, as decisions around reimbursement, insurance contracting, and federal regulation increasingly affect the specialty’s financial viability and patient access to imaging.
As the Medicare cuts and insurer policy move forward in 2026, Heller’s message was clear: The specialty must be ready to advocate forcefully and continuously for sustainable practice models, and for radiology’s role in delivering high-quality patient care.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]