由 John W. Mitchell
, Senior Correspondent | November 12, 2018
From the November 2018 issue of HealthCare Business News magazine
“When you think about it, imaging is expensive,” said Nelly Ganesan, senior healthcare consultant with Avalere Health. “The reimbursement they are submitting to CMS is pretty high. Even the four percent negative payment adjustment to an imaging center is going to be significant.”
According to Ganesan, the number of imaging measures in the MIPS program provides an opportunity for radiologists to do well in the value-based model. She expects that most radiologists will participate in the MIPS model, rather than in alternative care models (ACOs).
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“I do think the opportunity and ability for radiologists to receive the upward payments adjustments is pretty likely, given the ease of participation for them,” said Ganesan.
At last year’s RSNA meeting, a panel of physicians urged radiologists to get onboard with emerging with MACRA, MIPS and ACOs. Dr. Jim Whitfill, chief medical officer, Innovation Care Partners, and clinical associate professor, University of Arizona College of Medicine, spoke about the role of ACOs in meeting the new value-based compensation goals.
We checked in with Whitfill, who is also the new chair of the Society of Imaging Informatics in Medicine (SIIM), to find out how the ACO model is working. He reports that his practice, Scottsdale Health Partners, is scheduled to receive a $19.5 million payment from CMS for achieving savings under the ACO model. Their success represented the third-best result in terms of savings percentage in the U.S. this year, and the sixth best, based on total dollars saved in the delivery of primary care.
"Whereas many health systems need to have one foot in the fee-for-service canoe and one foot in the value-based canoe, we, at least in the clinically integrated network, are in the value-based canoe – that’s all we do,” said Whitfill. “We are owned by a larger health system that has to do both, but we’re a wholly separate subsidiary.”
Despite their success, Whitfill cautions that he believes the wholesale pivot from fee-for-service to value-based reimbursement is still several years away. But, Whitfill gives a lot of credit to the radiologists in their network of 1,800 physicians who are responsive in supporting value-based principles.