By: Dominic Siewko
The Centers for Medicare & Medicaid Services’ (CMS) recent final ruling on the implementation of the Medicare Access and Chip Reauthorization Act (MACRA) guidelines establishes new methods for determining physician reimbursement for caring for Medicare beneficiaries that seek to reward quality patient care and accelerate CMS’ goal of tying physician payment to performance.
While MACRA is statutorily required after passing into law in March of 2015, a surprising number of physicians still do not know it exists. As healthcare providers look to adhere to MACRA, they have the opportunity to make changes to their current practices and start linking their practices to the quality reporting metrics identified by the new payment system—many of which are specific to diagnostic imaging and radiation dose management. In fact, MACRA gives the radiology field a significant opportunity to showcase its impact and effect on the lives of patients using quantifiable metrics—if providers can measure them.
While there is no doubt concerning the critical role radiology has in the patient care experience, it is not always simple to benchmark, measure and improve diagnostic imaging practices. MACRA will significantly change this and is underscored by the industry’s focus on paying for value over paying for volume. However, these payment reforms present a unique challenge in radiology, as many hospitals and health systems are starting nearly from scratch as they look to evolve practices in their workflow and meet the more stringent performance metrics and requirements.
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There are several metrics for radiation dose management in the MACRA law, some of them being fairly straight-forward and some that may require a change in department procedures. While all of the proposed metrics are valuable, they also highlight areas of radiology care that have never been in focus like this before.
For example, the new metrics prescribe the use of low-dose equipment technology, which may require healthcare providers to upgrade their machines, particularly in CT, which could present an expensive obstacle for providers to tackle in order to fully participate in this new system. Another big emphasis of these metrics is on appropriate use criteria for ordering an exam, which will undoubtedly spur on debates as to whether or not some procedures are warranted.
Thus far, the gold standard for imaging has been first, justification of the procedure and second, management of dose to that specific patient. Now, however, we are starting to understand dose management as a factor of procedural justification, as opposed to an unrelated part of the imaging process. Follow-up CT exams for pulmonary nodule patients and head CT exams for patients with emergency medicine blunt force trauma are both examples of well-known procedures with widely debated clinical needs whose justification has never been approached in this specific way.