A higher number of radiologists are embracing value-based care by joining Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).

MSSP ACOs, which support the transition from volume to value-based care, saw participation from the specialty triple from 10.4% to 34.9% over five years, according to a new study by the Harvey L. Neiman Policy Institute.

"From an economic standpoint, value-based payment models offer the opportunity for radiologist to receive financial bonuses for high quality care. Also, radiologists are interested in avoiding future penalties and preparing for the future of value-based payments and shifting away from fee for service with renewed attention to advancing alternative payment models through MACRA and MIPS," first author Stefan Santavicca, of the Georgia Tech Health Economics and Analytics Lab (HEAL), told HCB News.

Established by the Affordable Care Act, the shared savings programs shift the basis for awarding economic incentives to providers from how many procedures they perform (volume) to how well they perform them (value) through the creation of quality and cost targets. They also impose financial penalties on those who do not meet these targets.

The researchers linked several separate 100% CMS data sets and found participating radiologists in 2018 in 90% of large ACOs. While this was only up from 88% in 2013, they also found participation increased twofold in small ACOs, from 26% to 52%. Participation in medium-sized ACOs rose from 63% to 66%, but the growth in participating radiologists in small ACOs is significant according to the researchers, because it signifies that shared savings programs are impacting radiologists even outside of urban, large specialty ACOs that have greater capacity for coordinating care.

The study, according to Santavicca, shows that value-bare care is reaching beyond patient-facing specialties to areas of medicine like radiology. As a result, she says, the stakes are only going up for radiologists to better prepare to work in healthcare organization evaluated through compensation contingencies, performance management programs and data-driven quality improvement initiatives.

"There is an opportunity to identify additional metrics that more directly tie care and services from radiologist to clinical and economic outcomes, and to carve out a more central place for radiologists in the care continuum where they are well positioned to (1) provide evidence-based clinical decision support for referring physicians, ensuring the highest value imaging study is selected that also minimizes patient risk, (2) to aid in advances in personalized medicine with more precise diagnoses and prediction, and (3) in the monitoring of disease treatment," said Santavicca.

Several international radiology associations, including RSNA, ACR and ESR, recently published a paper that called radiology a “key component” in value-based care and laid out nine steps for integrating it into value-based care and measuring, recognizing and augmenting its value.

A prior study from the Harvey L. Neiman Policy Institute in 2016, however, found that provider participation in ACOs occurs at a wide range of cost benchmarks, which, in turn, result in a wide range of physician provider shares. "In choosing a cost benchmark, CMS needs to consider the willingness of the ACO and its members to participate in the MSSP program. Different agents, such as hospitals, primary care physicians, and radiologists may have different thresholds of cost benchmarks in order to be willing to participate," Hui Zhang, one of the researchers, told HCB News at the time.

The findings of the current study were published in the Journal of the American College of Radiology.