HPC Corner: What is Radiology’s Role in Advanced Payment Models?

HPC Corner: What is Radiology’s Role in Advanced Payment Models?
Melissa Chen, MD

The latest results for the original iteration of a voluntary bundled payment model, a type of Alternative Payment Model (APM), the Bundled Payments for Care Improvement Initiatives (BPCI), were released last month.1  A bundled payment is one type of APM that links payments for multiple services received during an episode of care, such as acute stroke. BPCI is one of the largest tests of bundled payments to date. Although it does not meet the requirements of an Advanced APM, it has informed the development of the newest model, BPCI Advanced. Understanding of current models can help us prepare for how we might participate in APMs in the future. While most radiologists will likely participate in the fee-for-service (FFS) based payment system, Merit Incentive Payment Systems (MIPS) for a while, financial incentives and reporting burdens in MIPs will likely motivate increased adoption of APMs. After all, the intent for CMS was to have 50% of Medicare payments through APMs by this year.2

The recent results of BPCI confirmed earlier evaluations that showed decreasing total cost of care in episodes is attainable. The majority of clinical episodes in BPCI achieved this by decreasing the use of institutional post-acute care, specifically skilled nursing facilities (SNF). Some of this care was shifted to home health care, a lower cost provider. Organizations received bonus payments in BPCI if they could achieve an overall lower cost of care while maintaining quality as assessed by claims-based measurements and patient satisfaction surveys. Overall, CMS lost money in BPCI due to bonus payment reconciliations. Despite the loss, CMS will likely view these outcomes as positive results, particularly in light of the more dismal results of the Comprehensive Primary Care Initiative, where there was no significant change in spending growth or utilization.3

Although, no specific bundled payment model hinges solely on imaging, radiology plays a role in many episodes of care. As hospitals and physician groups move towards adoption of bundled payment models, imaging is viewed as a cost center rather than a revenue generator.

How can we ensure the value of our services is preserved? First, we can take an active role in appropriate imaging utilization. By reducing imaging that is of no value to patient care, we can reduce overall costs. Initiatives such as the American College of Radiology’s R-SCAN can help to jump-start your practice in this area. Additionally, as CMS focuses on maintaining or improving quality, we need to continue developing quality measurements relevant to our specialty. To do this, we must have standardized data that can be mined from our radiology reports to assess quality across all practices. The adoption of Common Data Elements (CDE) can facilitate this. Finally, we will continue to preserve the value of our services in FFS-based MIPS through our representation at the AMA RUC and CPT meetings. We can do this with your help in filling out the RUC surveys and maintaining memberships in the AMA, ASNR, and ACR.

References

  1. The Lewin Group. CMS bundled payments for care improvement initiative models 24: year 4 evaluation & monitoring annual report. October 2017.
  2. Burwell SM. Setting value-based payment goals — HHS efforts to improve U.S. health care. N Engl J Med 2015;372(10):897–99, 10.1056/NEJMp1500445.
  3. Peikes D, Dale S, Ghosh A, et al. The comprehensive primary care initiative: effects on spending, quality, patients, and physicians. Health Affairs 2018;37(6):890–99, 10.1377/hlthaff.2017.1678.

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