Radiologists: Take an active role in accountable care

The American College of Radiology's Radiology Integrated Care Network (RICN)--formerly called the Accountable Care Organization Network--published an opinion piece in the May issue of the Journal of the American College of Radiology in which it encourages radiologists to proactively get involved in ACOs.

"There are numerous practical lessons that can be learned and will be shared with other ACR members through RICN's activities," wrote RICN Chair David Rosman, M.D., and his colleagues. "One overwhelming initial conclusion is that radiologists must be engaged in the development and operation of these 'new' healthcare delivery models."

According to Rosman and his colleagues, while discussions focus on shared-savings ACO models, these have seen minimal cost benefits to the system, government or insurance companies, "although compliance with quality metrics has been encouraging."

If the ACO model fails, they say, the alternatives won't be appealing, as the government may require more cost reductions through bundled payments, additional quality metrics, single-payer insurance and other requirements.

Rosman and his colleagues also point out that while radiologists perceive themselves to have "targets on their backs" when it comes to cost cutting, ACOs have not focused on reducing imaging, but instead on reducing readmissions and reducing lengths of stays in acute care facilities and at skilled nursing facilities.

Additionally, they write, it's not clear that appropriate imaging utilization means lower utilization. Lower utilization, for example, could result in an increase in overall health system costs, since it could result in delayed discharge, unnecessary admissions and inaccurate patient assessment--all of which lead to inappropriate patient management.

There are advantages to radiology in the ACO model, according to the authors, such as the fact that it has favorable fixed-to-variable cost ratios and it's productivity can be predictably managed. Rosman and colleagues say, though, that radiologists have tended to stay out of the ACO planning and implementation arena because the focus has been on areas of medicine apart from imaging.

"Our RICN members suggest that this is exactly the wrong approach," they write. "It is easiest to integrate and become an integral part of the ACO decision-making team when not actively defending our turf. Our knowledge and training, combined with the tools we have developed, such as appropriateness criteria and decision support software, make us the providers who should manage imaging."

An earlier article--"Accountable Care Organizations and Radiology: Threat or Opportunity"--published in JACR last December, made a similar point, that ACOs, and other integrated health care delivery models could provide radiology with the opportunity to reassert its leadership and assume a more central role within healthcare systems.

To learn more:
- read the opinion piece in JACR
- here's the article from the December 2012 JACR

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