Radiologists wear a variety of hats these days. As healthcare continues to evolve, the radiologist’s many roles boil down to one question: which role is the most valuable?
The physician role, including that of the diagnostic radiologist, is under the microscope as the healthcare industry seeks new ways to define and prove the value of their services, and the best way to pay for them.
“The huge paradigm shift going on now in all of healthcare delivery, is this transition from volume to value, and certainly radiology needs to find its space in it,” said Richard Duszak, Jr., MD, vice chair for health policy and practice, department of radiology and imaging sciences at Emory University School of Medicine.
The traditional model of paying per radiology study performed is falling by the wayside as payers, both private and government, look to new models using data-driven metrics based on outcome and quality, or at least that’s the ultimate goal.
But value in healthcare has different definitions depending on whom you ask. For radiology, that might include imaging appropriateness and safety, efficiency, patient and referrer satisfaction, and quality.
“For me, value very loosely equals quality divided by cost. If I provide equal quality service at a lower cost, I’ve improved value,” Duszak said.
Where Are We Now?
Policy makers, payers, think-tanks and some medical groups are looking at how to implement value-based purchasing programs that compensate fairly for quality work and outcomes. “Conceptually getting from those ideas into reality and operationalizing it is a devil-in-the-detail situation,” Duszak said.
Fee-for-service payment does no favors in the quality realm, Duszak said. He gives an example of two chest X-ray reports, one written clearly and accurately, and one written as a single sentence replete with typographical and punctuation errors. The Centers for Medicaid and Medicare (CMS) pays both doctors $8.80 for the work. “This is the worst of fee-for-service,” he said. The movement toward value-based purchasing means that prices are dependent to some degree on service quality.
Showing value as a radiologist can be trickier than for most other specialties, especially as it relates to clinical outcomes. Making a brilliant call on an imaging study won’t give you a good clinical outcome score if the patient gets a suboptimal surgeon with high postoperative infection rate, and fares poorly after, Duszak said. If the surgeon isn’t up to standards and the overall health system is getting graded, that team will eventually boot out the surgeon. But until the whole team is engaged and working together on quality measures, it’s harder to measure a specific radiologist’s impact.
Physician Quality Reporting System
While many believe the Physician Quality Reporting System (PQRS) metrics are flawed Duszak believes it is a work in progress.
By statute, CMS is required to implement a physician value-based payment modifier for all doctors by 2017. They already initiated the program for groups that employ 100 or more eligible professionals, including physicians and clinicians billing under the Medicare Part B fee-for-service schedule.
In 2013, CMS started implementing the value modifier by looking at quality and cost measures and getting composite scores in each of those areas, said Judy Burleson, senior advisor on quality metrics at the American College of Radiology (ACR). Quality is on one axis, cost on the other, with low, average and high rankings for each. The score determines the potential for positive, negative or zero impact on reimbursement for Part B services. “If you’re low cost and high quality, you’d be in the upper spectrum,” she said. The physician’s performance report is compared to other physicians reporting the same measures.