Alternative Payment Models and Radiology

Healthcare is constantly changing, and part of that morphing has been the ever-shifting conversation about how providers should be paid for their performance, with the biggest push being toward a more value-based payment model. This move puts a growing onus on radiology to demonstrate the value it contributes to patient care.

But, as healthcare moves closer to this type of payment system, radiology and its practitioners must identify the challenges and opportunities presented. At this year’s AHRA: The Association of Medical Imaging Management annual meeting, John Carrino, MD, MPH, vice chairman of radiology of the Hospital for Special Surgery, discussed this paradigm shift.

“A lot of alternative payment models are based around the episode-of-care or surgical models, and they look at radiology as only sitting on the cost side of the ledger. They don’t always look at the quality of radiology being provided,” Carrino says. “But, there’s a value and a quality that radiology brings to overall patient care that needs to be addressed.”

One critical payment model opportunity for radiology, Carrino says, is bundled payment arrangements with other hospitals or large healthcare organizations. For example, radiology can play a significant role in orthopedic care, providing key images for hip or knee replacements.

“It’s really important for radiology to participate in these models because imaging can be the primary focus of getting a diagnosis,” he says. “Even if it’s just a couple of X-rays, radiology contributes positively to the care provided.”

Related article: How Value-Based Care is Affecting Radiology

As part of bundled payments, radiology ensures it’s viewed as an integrated service line, securing a seat at the table as a value-added partner. Without assuming this role, he says, radiology will continue to be considered a commodity and a cost-center.

It’s also imperative, he says, for radiology to participate fully with clinical decision support and appropriate use criteria to control over-utilization. In doing so, radiologists demonstrate their value as consultants and guides. Routinely discussing cases with referring providers, offering guidance about which tests to order, and providing context on reports, radiologists showcase themselves as integral team members.

“The criteria marries the ordering provider and the radiology group so that they both have skin in the game,” he says. “Radiology is only getting the most appropriate tests being ordered and the referring providers aren’t having to succumb to pre-certifications for their patients.”

Ultimately, Carrino says, radiology groups must exert effort to highlight the value they provide because it demonstrates to referring providers that it matters where they send their patients for imaging. Selecting the closest, lowest cost provider or one that attracts patients with coffee and snacks in the waiting room isn’t always the best option. They should look for a radiologist who strives to contribute significantly and actively to the patient’s care.

“The healthcare landscape is changing, and imaging is going to be even more scrutinized that ever before in the past. There’s going to be a focus on value over volume, and it’s important to be engaged,” he says. “Radiology groups should be working closely with other organizations to actively show the value they provide.”