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What should alternative payment models look like in radiology?

by John R. Fischer, Senior Reporter | December 16, 2022
Insurance Primary Care
Drs. Kavita Patel and Mark McClellan discuss alternative payment models for radiology at RSNA.
Amid Medicare payment cuts, inflation, and supply and worker shortages, many radiologists are viewing alternative payment models as a desirable shift from the traditional fee-per-service model. The subject was addressed by a panel during the RSNA meeting, entitled Medicare and U.S. Healthcare Policy: A National Conversation.

By basing payment on quality of care, alternative payment models incentivize providers to focus more on things like appropriate imaging and having the right resources for post-acute care, which, in turn, reduce total cost. But in doing so, specialists take on different roles that CMS must figure out how to reimburse them for, says Dr. Mark McClellan, an economist and the Robert J. Margolis Professor of Business, Medicine, and Policy at Duke University.

“What we haven’t seen yet in radiology, but in other specialties, is this move toward paying more for a longitudinal component with this more comprehensive active role in patient management," he said. "The challenge for radiology is figuring out what that future looks like, the ideal practice we’re aiming for and how to get payment reforms to support us in getting there."

Demand for imaging is expected to increase in the coming years, meanwhile Medicare populations are projected to expand with rising income inequality. Other factors, such as new technologies like AI, consolidation trends and shifts of care from hospitals to broader settings like outpatient clinics and at home, will affect the cost and quality of these services.

All of these must be accounted for in any alternative payment model that radiologists use, said Dr. Kavita Patel, a primary care doctor and the former director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. They also must make clear to policymakers their needs, and how cuts in spending impact not just the care of patients but their ability to fulfill obligations they have to referring physicians.

Patel encouraged radiologists to discuss their individual needs and share best practices among each other, as well as with other medical professionals.

“How do we get more women to get their mammograms at the specified times? In the case of diagnostic imaging, how do we have follow-up imaging and understanding of best practices so we can avoid these care gaps? These conversations should be more commonplace in your profession."

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