RSNA 2017: The case for evidence-based advocacy for radiology

Basing research and best practices on evidence is nothing new. But for radiologists to best represent their professions to federal lawmakers and regulators, their advocacy should be evidence-based, argued Emory University’s Rich Duszak, MD, professor and vice chair for health policy and practice at the school’s Department of Radiology and Imaging Sciences at RSNA 2017 in Chicago.

Duszak said the current policy-making and regulatory environment can look like a “rollercoaster going off the rails” to radiologists and all physicians. The traditional ways of advocacy—such as meeting with a member of Congress at their Capitol Hill office with your professional society and arguing in favor of certain legislation—need to be backed up by data and “robust health policy research” to effectively drive policy. Otherwise, Duszak said “you’re just another person with an opinion” asking a legislator for something.

“When I hear people talking about bench to bedside [continuum in translational research]," Duszak said, “they’re missing the two important ‘Bs’ in the middle: the Beltway bureaucrat. If we can’t convince that group of legislators, regulators, payers that these things are important, then those things never really get translated into clinical practice as quickly or as robustly as we might like.”

Coming armed with evidence when advocating for policy sometimes helps fight misconceptions. Duszak offered an example of policymakers assuming that patients undergoing CT in the emergency department “aren’t really sick.” Advocates could point to an ED physician’s own contemporaneous coding to show the complexity of those patients. That kind of evidence, Duszak said, help illustrate the value of certain services to regulators and policymakers.

Bundled payment models affecting radiologists may be one area where this evidence-based advocacy comes in handy. Duszak said the American College of Radiology, among others, has been working on how those models would work, which can put radiologists in a “much more advantageous position” than leaving the structure of a bundle up entirely to CMS.

The approach has already had an impact. Duszak said evidence-based advocacy helped roll back the Multiple Procedure Payment Reduction (MPPR). This Medicare reimbursement reduction on interpretation of advanced imaging scans performed on the same patient in the same session was initially set at 50 percent, as CMS argued same-day advanced imaging should be more efficient. After RADPAC got involved, the reduction was temporarily reduced to 25 percent and later 5 percent thanks to a provision included in a 2015 spending bill.

The return on investment is there, Duszak said, estimating policy research backing up advocacy efforts on the MPPR rollback will increase Medicare payments to radiologists in 2017 by at least $3,000—or more than $50 million for radiologists nationwide.

“My plea to you here is think about supporting your profession,” Duszak said.