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Challenges for radiologists in a value-based care model

by John W. Mitchell , Senior Correspondent
Imagine a world where radiologists act more as primary care providers, driving cost reductions and better outcomes, all while getting a monthly payment from each member of a population health management plan.

That was one of the possible scenarios laid out in the latest Society for Imaging Informatics in Medicine (SIIM) webinar last Thursday. Dr. James Whitfill was the presenter in a webinar titled "Where does imaging fit in a value-based care world?".

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Whitfill, who has guided the value-based payment (VBP) transition in his own multi-specialty practice, and also consults with other physician entities on the topic, made the case to an audience of 241 attendees.

"Imaging does not naturally fit into many of the outcomes-driven value-based models," Whitfill told HCB News. "Typical barriers include the lack of data to show that imaging affects hard outcomes like total medical cost or admissions to a hospital. This makes it harder for imaging to justify its role in a VBP model."

Whitfill walked onlookers through the realities of rising health care costs with an array of data and charts. He said all the players in health care - business, government, and patients — are near exhausting their ability to fund health care under the traditional fee-for-service model. Further, this rising trend in health spending — which is at about 17 percent of gross national product — has some potentially serious consequences.

"Our ability to compete in global markets will be diminished once health care spending exceeds 20 percent in the U.S.," he predicted.

He reminded the audience that starting in 2020 automatic reimbursement increases will end. Physicians, including radiologists, will then be subject to payment increases or decreases under the Merit Incentive Payments System (MIPS) depending on how they perform on cost and quality metrics. By 2022, low-performing radiologists could see their payments begin to drop nine percent a year.

Whitfill warned that in a value-based system, imaging is at risk of becoming a cost center, rather than the traditional revenue center. He acknowledged the work of the American College of Radiology (ACR), and its Imaging 3.0 program, to prepare for VBP and MIPS. However, he said imaging might need to consider more radical, faster changes.

"One of the largest barriers to this effort is the volume focus on imaging and the threat of commoditization," he said. "Compensation and workflow are set up to maximize RVU production, which runs at odds with any VBP strategy."

He proposed several possible actions radiologists might take. Because they are already skilled in informatics, and connected to all specialties, there is the possibility that radiologists could devise best practices to guide population wellness management. Whitfill also advised that radiologists get involved with health system governance to understand VBP issues and challenges better.

This, he said, would be a way for radiologists to help health systems that take on risk-based contracts reduce costs and improve outcomes. Radiologists might even do this themselves under a risk-based scenario, getting paid for each member per month.

"Some radiology practice is going to figure this out," he predicted, noting the alternative is for radiologists to become an outsourced reading service in a future that will include getting compensated as part of bundled payments. "To avoid this kind of result, radiologists need to engage clinicians and patients in a much greater manner."

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