"You have to replace needles, you have to replace rubber gloves and you have to do certain test procedures. But some people may not view spending money or setting aside money every year for capital equipment as a necessary part of business," Fisher said.

MITA is working on a set of proposals, but Fisher said it was too early to share them yet. He did say the main concern was that ACOs focus on quality of care and not just cost, and that getting new equipment is critical for patient health.


"Nobody would argue that imaging technologies aren't quickly advancing," he said. "For example, with CT, [we can now get the] same quality of image with less radiation. They are all important and necessary for continuing to improve our health care system."

Appropriateness Criteria

One suggestion separately brought up by the manufacturers and radiologists is to somehow incorporate the ACR Appropriateness Criteria for imaging into an ACO model, as a way to bring an evidence-based quality-control measure.

"Capitation without utilization based on appropriateness criteria - that's bad," Allen said.

"The wrong way to do it is to decide, the CT scan cost too much, or we spent our budget on MRI this month, so we can't do it," Fisher observed.

ACO pilot

But it's still the early days, and it's not clear how it's going to work out, even among groups already starting similar programs.

Performance improvement group and group purchasing organization Premier Healthcare Alliance is currently working with its member hospitals to set up ACOs. Launched in May, the group has two programs, one for hospitals ready to start implementing an ACO model, and the other for hospitals that need to develop the infrastructure first. A Premier spokeswoman told DOTmed News around 24 hospitals joined the implementation collaborative and close to 60 are enrolling in the readiness one.

The group said hospitals are still working out the specifics, but Premier is optimistic that many radiologists have nothing to fear, as this won't be a replay of the 1990s.

"By and large, if you're a high-value radiology provider, then there shouldn't be a significant change in volume or reimbursement," Brent Hardaway, a principal with Premier Consulting Solutions, told DOTmed News.

"In the 90s it was only cost-based, but today we have the offsetting quality and outcomes and patient satisfaction components," he added.

"We're going to want people to be happy with the care they receive. If people are feeling like they're being imaged on a 30-year-old piece of equipment, they're not going to be very happy. I think I understand the concern that there will be less money for capital equipment purchases. But I would say we have to be very careful about limiting capital equipment purchases."

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