News | Radiology Business | December 28, 2016

Report Examines MACRA’s Impact on Radiologists

MACRA, MIPS, QPP, radiology, impact on radiologists

December 28, 2016 – A new Harvey L. Neiman Health Policy Institute series of reports explores the impact of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, along with the Centers for Medicare and Medicaid Services’ (CMS) 2016 proposal for its implementation, on radiologists. The work, conducted by a team of radiologists and health services researchers, is published online in the Journal of the American College of Radiology (JACR).

Under MACRA, most radiologists will initially be paid through the Merit-Based Incentive Payment System (MIPS), which applies positive or negative adjustments to fee-for-service payments. In April 2016, CMS published an initial proposed rule for MACRA, renaming it the Quality Payment Program (QPP) that will ultimately link a very large fraction of physicians’ Medicare payments to the quality and value of care. Payment adjustments under MACRA will begin in 2019, although they will reflect performance during 2017.

The first part of the JACR series provides an overview of CMS’ proposal for implementing MACRA legislation via the new QPP, paying specific attention to the implications and imperatives for radiologists under MIPS.

“Given that the initial MIPS performance period begins in 2017, radiologists must begin preparing for QPP and taking actions to ensure their future success under this new quality-based payment system,” said Andrew Rosenkrantz, M.D., MPA, the lead study author and a Neiman Institute affiliate research fellow.

In the second part of the series, the researchers found that CMS’ proposed criteria for special considerations in new payment models would result in many radiologists being evaluated using measures not reflective of their practice.

“MIPS will provide special considerations for physicians with a limited degree of face-to-face patient interaction,” said Bibb Allen Jr., M.D., FACR, chair of the Neiman Institute advisory board and past chair of the American College of Radiology Board of Chancellors. “However, using CMS’s proposed criteria for which physicians will receive special considerations, many radiologists will be deemed ineligible for these special considerations and thus be evaluated based on performance categories beyond their control.”

“Alternative criteria could help ensure that radiologists are provided a fair opportunity for success in performance review under MIPS,” added Rosenkrantz.

The ACR applied concepts developed in these articles to inform CMS that determination of special considerations based on face-to-face patient interaction for payment policy purposes may best be defined in terms of the number of Evaluation and Management services performed, while the number of minor procedures performed is not as useful in that determination. 

On Oct. 14, 2016, CMS released its final rule for MACRA implementation. This final rule modified the criteria for special considerations under MIPS, consistent with earlier ACR feedback. As now defined, at minimum, nearly 90 percent of diagnostic radiologists and 40 percent of interventional radiologists will be eligible for the special considerations and these numbers could increase to 99 percent and 87 percent if CMS determines that procedural services will not be included in its determination of patient facing status. The protections provided to radiologists by the latest modifications from CMS are supported by the data demonstrated in the second part of the series.

Rosenkrantz, Allen and their colleagues noted that continued investigation is warranted to optimally determine the extent of radiologists’ face-to-face patient interactions.

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. 

Read the JACR article “The Proposed MACRA/MIPS Threshold for Patient-Facing Encounters: What It Means for Radiologists.” 

Read the article "HHS Finalizes Bundled Payments for Cardiac, Orthopedic Care."

For more information: www.neimanhpi.org 

Related Content

Scranton Gillette Communications Names Imaging Technology News Group Publisher and Integrated Media Consultant

Diane Vojcanin (left) was named vice president, group publisher, healthcare group, overseeing Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC). Andreja Slapsys (right) was named a healthcare group integrated media consultant.

News | Radiology Business | September 06, 2019
Business-to-business communications leader Scranton Gillette Communications has named Diane Vojcanin as vice president...
Sudhen Desai, M.D.

Sudhen Desai, M.D.

Feature | Pediatric Imaging | September 04, 2019 | By Jeff Zagoudis
Burnout has become a popular buzzword in today’s business world, meant to describe prolonged periods of stress in the
Medical Imaging Rates Continue to Rise Despite Push to Reduce Their Use
News | Radiology Imaging | September 03, 2019
Despite a broad campaign among physician groups to reduce the amount of medical imaging, use rates of various scans...
The Siemens Ysio Max digital radiography system.
Webinar | Digital Radiography (DR) | September 03, 2019
The Webinar "Benefits of Advanced Automation in X-ray" will be presented Wednesday, Sept. 25 at 1 p.m.
A SPECT nuclear scan of the heart to show perfusion defects in the myocardium due to coronary artery blockages or heart attack. The imaging uses the Mo-99 based medical imaging isotope Tc-99m. The U.S. government has created policy to move away from use of highly enriched uranium (HEU) to low-enriched uranium (LEU) for Mo-99 isotope production, but there is one hold out who has not yet converted before a 2020 deadline. Photo courtesy of Philips Healthcare.

A SPECT nuclear scan of the heart to show perfusion defects in the myocardium due to coronary artery blockages or heart attack. The imaging uses the Mo-99 based medical imaging isotope Tc-99m. The U.S. government has created policy to move away from use of highly enriched uranium (HEU) to low-enriched uranium (LEU) for Mo-99 isotope production, but there is one holdout who has not yet converted before a 2020 deadline. Photo courtesy of Philips Healthcare.

Feature | Nuclear Imaging | August 30, 2019 | Dave Fornell, Editor
In a surprising move, the National Institute for Radioelements (IRE) has applied for a new license to export highly e
Beginning with the 2019 meeting, the American Society for Radiation Oncology (ASTRO) will begin transforming its annual meeting in several key ways

Expect changes at ASTRO 2019 and at ASTRO annual meetings to come over the next two years. Photo courtesy of ASTRO

Feature | ASTRO | August 30, 2019 | By Greg Freiherr
Beginning with the...
RSNA Announces New Global Learning Centers Program
News | Radiology Business | August 26, 2019
The Radiological Society of North America (RSNA) is launching a new RSNA Global Learning Centers (GLC) program...
Videos | Computed Tomography (CT) | August 21, 2019
This is a quick walk around of a mobile 32-slice...
The top piece of content in July was a video interview explaining how Princess Margaret Cancer Center is using machine learning to create automated treatment plans. This was a hot topic at the American Association of Physicists in Medicine (AAPM) 2019 meeting in July.

The top piece of content in July was a video interview explaining how Princess Margaret Cancer Center is using machine learning to create automated treatment plans. This was a hot topic at the American Association of Physicists in Medicine (AAPM) 2019 meeting in July. 

Feature | August 05, 2019 | Dave Fornell, Editor
August 5, 2019 — Here is the list of the most popular content on the Imaging Technology New (ITN) magazine website fr
Videos | Radiology Business | August 02, 2019
Association for Medical Imaging Management (AHRA) President ...