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Pat Free

Radiologists’ success hinges on preparation and collaboration in 2017

By Pat Free

RSNA 2016 was focused around helping improve radiology both clinically as well as financially in the New Year – ranging from tactics like operational efficiency to more in-depth EHR integration and reporting. Radiology is well known within the medical specialties to be the specialty where nearly all hospital diagnosis is determined or confirmed. Meanwhile, over the course of the past 12 years, radiology has seen significant cuts to reimbursement. Therefore, radiology groups need to identify ways to remain viable, vibrant and grow while the healthcare landscape continues to change. Looking ahead towards 2017, radiologists will need to consider two trends on the horizon – their reimbursement model and their growth strategy.

Reimbursement Under MIPS
Under MACRA, the Merit-based Incentive Payment System (MIPS), one of two payment models CMS offers, begins in January of 2017. MIPS will bring a wide variety of changes to how radiologists will be reimbursed and it’s estimated that at least 90 percent of radiologists will report through MIPS. The other clinicians will qualify with their hospital’s Advanced Payment Model or APM. Regardless of the model, it is imperative that all radiologists become knowledgeable and in many cases engaged in helping manage and monitor their specific program over the course of the next few years.

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To succeed, radiologists should have an understanding of the several categories they will get scored in and receive payment on. MIPS combines three prior, separate programs with the addition of a fourth segment, Improved Activities. However, CMS decided to postpone the launch of one of those four categories, the resource use/cost performance category, until the start of the 2018 performance year. The challenge will be in selecting the measures that best fit the group to help insure successful reporting. Some factors that deter radiologists from fully embracing early MIPS preparation is their lack of experience or proper tools. For example, not previously participating in the Physician Quality Reporting System (PQRS), or not having the administrative infrastructure to develop the program could be detrimental. Based on a group’s final score, they can receive up to a four percent increase in their 2019 Medicare payments, with additional bonuses if they surpass the baseline. Likewise, doing nothing will automatically generate a four percent penalty. Therefore, starting early is always the best answer so radiologists can gain experience while there are favorable payment adjustments being offered and the stakes aren’t as high.
  Pages: 1 - 2 - 3 >>

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