Radiologist: How the ACA will impact medical imaging reimbursement

As healthcare reform unfolds, the Centers for Medicare & Medicaid Services is in the process of testing a number of payment policy options such as pay-for-performance, bundled payments and shared savings through accountable care organizations. In an article in the Journal of the American College of Radiology, Andrew Bindman, M.D., of the University of California, San Francisco, writes that radiologists should expect this will result in a change in the way they get paid by Medicare.

These different payment approaches or strategies each incentivize performance. Pay-for-performance, for instance, rewards or penalizes physicians financially in order to incentivize quality care. The Physician Quality Reporting System provides a 1 percent Medicare bonus that's tied to reporting on quality health measures, and will over time be tied to actual performance. In addition, the program eventually will include penalties up to 2 percent for physicians who don't participate or are unsuccessful.

Meanwhile, bundled payments for discrete episodes of care cover physician, hospital and post-acute care costs, including laboratory and imaging studies. According to Bindman, since the allocation of the bundled payment is at the discretion of the entity contracting, radiologists should be prepared to demonstrate the value of the services they are providing.

While bundled payments are being tested for groups of patients with specific clinical issues, an ACO is payment model for a broad population of patients.with a variety of clinical needs, Bindman says. These organizations are accountable for all of the costs associated with delivering care to their patient population, and consequently have a financial incentive to identify and treat clinical problems at an early, less costly stage. This means that within this kind of model, radiologists have the ability to demonstrate value by using imaging for cost-effective screening and prevention programs (such as CT lung cancer screening programs).

"How fast and how far ranging these changes ultimately will be is not predetermined," Bindman says. "However, radiologists can anticipate that the basis for how they are paid will change and that they will need to play a greater role than has been required of them in the traditional fee-for-service payment system to demonstrate that imaging studies are used safely and efficiently."

To learn more:
- see the article in the Journal of the American College of Radiology
- read about the Physician Quality Reporting System program

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