ACR shares concerns about specialty’s ‘struggle’ to participate in alternative payment models

The American College of Radiology is sharing concern around the specialty’s “struggle” to participate in alternative payment models.

ACR voiced its views in a Tuesday, Aug. 1, letter to the Physician-Focused Payment Model Technical Advisory Committee, which makes recommendations to Health and Human Services. Barriers to radiologists’ ability to excel in the Merit-based Incentive Payment System include their ineligibility to earn maximum incentive adjustments, despite perfect performance in the program.

That’s because there are a limited number of MIPS clinical quality measures equating to 10 points, along with a lack of attribution to episode-based cost and promoting interoperability measures, the college wrote.

“The ACR recognizes the importance of ensuring that radiologists participate in [alternative payment models], due to the major role imaging plays in achieving better quality and cost savings through the rendering of an early diagnosis,” the letter stated. “However, such opportunity is clearly lacking in the current state, based on an insufficient number of disease-based or episode-based APMs. Participation in many APMs, such as [accountable care organizations] and patient-centered medical homes, is only available to primary care providers. Relevant advanced APMs are particularly limited for radiologists.”

The feedback comes in response to a recent request for information from the Physician-Focused Payment Model Technical Advisory Committee, or PTAC, exploring the integration of more specialty care into population-based models. PTAC has held a series of discussions this year about the topic, hoping to better advise politicians, payers, and ACOs about ways to bring value-based care to specialties such as radiology. ACR said such an effort “provides a compelling opportunity for radiologists to demonstrate and earn rewards for their unique contributions toward patient care.”

The college suggested that possible physician-focused payment models in radiology could focus on breast, lung and colorectal cancer screening, along with cancer staging and follow-up, either as standalones or integrated into multispecialty models.

“Diagnostic radiologists are critical to the patient care path,” the letter concluded. “The value they provide is evident to patients whose screening exams or AIF follow-up recommendations result in early disease detection, their treating clinicians who use the imaging results and radiologists’ recommendations to inform on treatment next steps, and healthcare payers responsible for the costs associated with the downstream effects of cancer treatments. Additionally, diagnostic radiologists’ identification of non-pertinent imaging findings is crucial for establishing cost savings as these results inform on unnecessary therapies frequently associated with the presenting health problem.”

PTAC said it will use responses to its request to help further inform its review of recommendations the committee may provide to the HHS secretary on this topic.

You can find the full RFI here, along with ACR’s response letter and a related news update posted Aug. 3.