Funds Flow in the Era of Value-Based Health Care.

Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers' focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances. Funds flow is the primary mechanism whereby an AMC maintains the triple mission through alignment of the hospital, physician practices, school of medicine, undergraduate university, and other professional schools. The purpose of this article is to discuss challenges with current funds flow models, impact of funds flow on academic and private practice radiology groups, and strategies that can increase funds flow to support radiology practices achieving clinical, research, and teaching missions in the era of value-based health care.

Impact of the Professional Component MPPR Policy on Interdivisional Finances in an Academic Radiology Department.

PURPOSE: The professional component (PC) Multiple Procedure Payment Reduction (MPPR) policy reduces reimbursement for two or more imaging services rendered by the same group practice for a single patient in a single session. The purpose of this study was to analyze the impact of the PC MPPR on interdivisional finances in an academic radiology department. METHODS: A retrospective analysis of Medicare collections from imaging services rendered by a single academic radiology department in a tertiary care medical center for calendar year 2014 was performed. The impact of the PC MPPR on each division was calculated as the fraction of the total departmental PC MPPR, and as the proportion of the divisional revenue. RESULTS: The total decrease in Medicare collections as a result of the PC MPPR was 5.35%. The impact of the PC MPPR on each division as a fraction of the total departmental PC MPPR was: abdominal division (16.63%); thoracic division (23.56%); breast division (0.03%); musculoskeletal division (11.92%); neuroradiology division (34.40%); and noninvasive cardiovascular division (13.46%). The impact of the PC MPPR on each division as a fraction of the divisional revenue was: abdominal (2.82%); thoracic (11.83%); breast (0.66%); musculoskeletal (6.01%); neuroradiology (5.31%); and noninvasive cardiovascular (5.85%). CONCLUSIONS: The PC MPPR differentially affects divisions within an academic radiology department. The neuroradiology and thoracic divisions of our department were the most adversely affected, owing to the high frequency of combined examinations. We speculate that this impact has implications for divisional self-sufficiency, interdivisional relationships, and resident decision making regarding subspecialty training.

The impact of the Patient Protection and Affordable Care Act on radiology: beyond reimbursement.

The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology's role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape.

Do we need a national incident reporting system for medical imaging?

The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal.

When does a radiologist's recommendation for follow-up result in high-cost imaging?

PURPOSE: To measure the proportion of high-cost imaging generated by a radiologist's recommendation and to identify the imaging findings resulting in follow-up. MATERIALS AND METHODS: This retrospective HIPAA-compliant study had institutional review board approval, with waiver of informed consent. A recommended examination was defined as one performed within a single episode of care (defined as fewer than 60 days after the initial imaging) following a radiologist's recommendation in a prior examination report. Chest and abdominal computed tomography (CT), brain and lumbar spine magnetic resonance (MR) imaging, and body positron emission tomography were included for analysis. From a database of all radiology examinations (approximately 200,000) at one institution over a 6-month period, a computerized search identified all high-cost examinations that were preceded by an examination containing a radiologist recommendation. Medical records were reviewed to verify accuracy of the recommending-recommended examination pairs and to determine the reason for the radiologist's recommendation. For proportions, 95% confidence intervals were calculated. RESULTS: Overall, 1558 of 29,232 (5.3%) high-cost examinations followed a radiologist's recommendation. Chest CT was the high-cost examination most often resulting from a radiologist's recommendation (878 of 9331, 9.4%), followed by abdominal CT (390 of 10,258, 3.8%) and brain MR imaging (222 of 6436, 3.4%). The examination types with the highest numbers of follow-up examinations were chest radiography (n=431), chest CT (n=410), abdominal CT (n=214), and abdominal ultrasonography (n=120). The most common findings resulting in follow-up were pulmonary nodules or masses (559 of 1558, 35.9%), other pulmonary abnormalities (150 of 1558, 9.6%), adenopathy (103 of 1558, 6.6%), renal lesions (101 of 1558, 6.5%), and negative examination findings (101 of 1558, 6.5%). CONCLUSION: Radiologists' recommendations account for only a small proportion of outpatient high-cost imaging examinations. Pulmonary nodule follow-up is the most common cause for radiologist-generated examinations.