Radiology’s reimbursement rub

Radiology’s reimbursement rub

Sean Ruck, Contributing Editor | February 18, 2020
From the January/February issue of HealthCare Business News magazine

Teleradiology also has its part in the discussion. Although it’s not known for face-to-face interactions, there are still the periodic multidisciplinary conferences and increasing opportunities for virtual collaboration — PACS-supported Skype conferencing for instance.

One aspect of value messaging radiologists have little control over is the reimbursement model. Obviously organizations like ACR and AHRA can help steer some legislative discussions, but they’re pulling on the tiller of a cruise ship. For HSS, a specialty hospital focused on orthopedics, rheumatology and musculoskeletal disease, that’s unfortunate according to Fleury. That’s because a lot of the quality measures when the Medicare Access and CHIP Reauthorization Act (MACRA) were introduced and tweaks that were made to the Merit Based Incentive Payments System (MIPS), weren’t applicable to HSS’ focuses.

“I can’t speak for other groups, but I would think they’re also using similar terms like ‘surrogates to quality’ because we’re all trying to do things like reduce dose to patients and infection rates in procedure-based services. But really, your true quality outcome measures are not being captured, I think because a lot of people are having a hard time defining them. You may be collecting smoking status on patients and infection control best-practices for patients, and striving to reduce radiation dose as much as possible, but in the end, does it really deliver better quality of care?” he says.

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Carrino believes physicians need a bigger voice in explaining what defines healthcare quality. But at the same time, as those discussions occur, if people want higher quality, the value to cost equation will tilt further.

As patients pair their growing savvy at navigating the internet with an increasing understanding about their own health care, they’ll ultimately make the decision for transparency related to value and cost. Before that time comes, Fleury says it’s important to be very clear on the value side or benefit side of those costs. “So in that way, the patients can get the full story — they may be paying more for services. Are they getting more? Are they getting better quality? Organizations are really going to have to have that message down very well.”

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