MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians' Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs.

Enriched Audience Engagement Through Twitter: Should More Academic Radiology Departments Seize the Opportunity?

PURPOSE

The aim of this study was to evaluate use of the microblogging social network Twitter by academic radiology departments (ARDs) in the United States.

METHODS

Twitter was searched to identify all accounts corresponding with United States ARDs. All original tweets from identified accounts over a recent 3-month period (August to October 2014) were archived. Measures of account activity, as well as tweet and link content, were summarized.

RESULTS

Fifteen ARDs (8.2%) had Twitter accounts. Ten (5.5%) had "active" accounts, with ≥1 tweet over the 3-month period. Active accounts averaged 711 ± 925 followers (maximum, 2,885) and 61 ± 93 tweets (maximum, 260) during the period. Among 612 tweets from active accounts, content most commonly related to radiology-related education (138), dissemination of departmental research (102), general departmental or hospital promotional material (62), departmental awards or accomplishments (60), upcoming departmental lectures (59), other hospital-related news (55), medical advice or information for patients (38), local community events or news (29), social media and medicine (27), and new departmental or hospital hires or expansion (19). Eighty percent of tweets (490 of 612) included 315 unique external links. Most frequent categories of link sources were picture-, video-, and music-sharing websites (89); the ARD's website or blog (83); peer-reviewed journal articles (40); the hospital's or university's website (34), the lay press (28), and Facebook (14).

CONCLUSIONS

Twitter provides ARDs the opportunity to engage their own staff members, the radiology community, the department's hospital, and patients, through a broad array of content. ARDs frequently used Twitter for promotional and educational purposes. Because only a small fraction of ARDs actively use Twitter, more departments are encouraged to take advantage of this emerging communication tool.

Imbalance of opinions expressed on Twitter relating to CT radiation risk: an opportunity for increased radiologist representation

OBJECTIVE

The purpose of this study was to assess perspectives and information relating to CT radiation risk on Twitter, a popular microblogging social network.

MATERIALS AND METHODS

Publicly available posts on Twitter ("tweets") containing both the words "CT" and "radiation" were identified from the 1st week of each month in 2013. Type of user posting and source of linked articles were recorded. Two reviewers assessed the content of tweets and links regarding CT's benefit-to-risk ratio (favorable, unfavorable, etc.).

RESULTS

Six hundred twenty-one relevant tweets were tweeted by 557 unique users, of whom 90 (16%) were physicians (17 of these were radiologists), 30 (5%) were medical practices or hospitals, 34 (6%) were patients, 8 (1%) were physicists or technologists, and 395 (71%) were other types of users. Two hundred twenty-seven tweets included user commentary regarding CT's benefit-to-risk ratio, of which 134 (59%) were unfavorable or concerned, 65 (29%) were neutral, 22 (10%) were informative regarding CT dose reduction strategies, and only 6 (3%) were favorable. Four hundred seventy-two tweets (76%) included links to a total of 99 unique articles, of which 25 (25%) were unfavorable or concerned, 10 (10%) were favorable, 25 (25%) were neutral, and 39 (39%) were informative regarding CT dose reduction. Article types were non-peer-reviewed medical sources (n = 50), lay press (n = 15), peer-reviewed medical journals (n = 13), blogs (n = 12), advertisements (n = 5), and informational websites (n = 4).

CONCLUSION

The large majority of content on Twitter was either unfavorable or concerned regarding CT radiation risk. Most articles were not peer-reviewed and were posted by nonphysicians; posts by physicians were largely by nonradiologists. More active engagement on Twitter by radiologists and physicists and increased dissemination of peer-reviewed articles may achieve a more balanced representation and alleviate concerns regarding CT radiation risk on social networks.

Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening

BACKGROUND

Newly released United States Preventive Services Task Force (USPSTF) recommendations for lung cancer screening are expected to increase demand for low-dose computed tomography scanning, but health system capacity constraints might threaten the scale-up of screening.

OBJECTIVES

To estimate the prevalence of capacity constraints in the radiologist workforce and resulting potential disparities in access to lung cancer screening.

METHODS

We combined information from health interview surveys to estimate the numbers of smokers who meet the USPSTF eligibility criteria, and information from administrative datasets to estimate the numbers of radiologists and the numbers of scans they currently interpret in Health Service Areas (HSAs) nationwide. We estimated and mapped the prevalence of capacity constrained HSAs - those having a greater than 5% or greater than 25% projected increase in scans over current levels from scaling up screening - and used descriptive statistics and logistic regressions to identify HSA characteristics associated with capacity constraints.

RESULTS

Scaling up lung cancer screening would increase imaging procedures by an average of 4% across HSAs. Of the 9.6 million eligible smokers, 1,023,943 lived in HSAs with increases of at least 5%. HSAs that were rural, with many eligible smokers, and disproportionately Hispanic or low-income smokers had significantly higher odds of facing capacity constraints.

CONCLUSIONS

Disparities in access to lung cancer screening appear likely unless policy makers target HSAs with few radiologists for additional resources. Radiologists should be able to absorb the workload imposed by lung cancer screening in most areas of the country.

Work and retirement preferences of practicing radiologists as a predictor of workforce needs

RATIONALE AND OBJECTIVES

The radiology job market has been described as highly variable, and recent practice hiring surveys predict that the number of available jobs will remain flat. Radiologists may be working more hours and retiring later than desired, activities that influence overall job availability. A national survey was performed to determine the desired work rate and retirement preferences of practicing radiologists, and the responses are used to estimate current and potential future work output and future workforce needs.

MATERIALS AND METHODS

Practicing radiologists were surveyed regarding current and preferred work level and desired and expected retirement age. A model incorporating these preferences and stratified by age was developed using survey responses and American Medical Association full-time equivalent (FTE) estimates. Available FTE radiologists are estimated under four scenarios from 2016 to 2031 in 5-year intervals.

RESULTS

The model predicts a total of 26,362 FTE radiologists available in 2011, which corresponds to previous estimates. Participants reported working more hours and expecting to retire later than desired, with younger radiologists and women reporting the greatest desired decrease in FTE hours worked. Under each scenario, there is an initial FTE availability in 2016 ranging from 21,156 to 24,537, which increases to between 27,753 and 31,435 FTE by 2031 depending on work rate and retirement patterns.

CONCLUSIONS

Practicing radiologists report that they currently work more hours than desired and expect to retire later than they would prefer. If radiologists changed current personal work rate and expected retirement age to meet these preferences, there would be an immediate shortage of FTE radiologists continuing until at least 2020 assuming no other workforce needs changes.

Of mice and men: escaping the relative value unit trap

Although radiologists have kept pace with the dramatic growth of medical imaging during the past two decades through the use of PACS, digital dictation, and 3-dimensional reconstruction, radiology is approaching the point of diminishing returns. As reimbursements further decline, attempts to increase radiologists' productivity risk commoditization of the specialty. The continued evolution of US health care policy, however, presents an opportunity for radiologists, using their core competencies, to shape the future direction of medicine.

The 2013 ACR Commission on Human Resources workforce survey

BACKGROUND

The ACR Commission on Human Resources conducts an annual electronic survey during the first quarter of the year to better understand the present workforce situation for radiologists.

METHODS

We used the Practice of Radiology Environment Database (PRED) to identify 2,067 practice leaders and asked them to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders or their designates to report the number of radiologists they currently employ or supervise, the number hired in 2012, and the number they plan to hire in 2013 and 2016. The leaders were also asked to report the subspecialty area that was used as the main reason for hiring that physician.

RESULTS

Of the 2,067 practice leaders surveyed, 22% responded, a figure corresponding to 23% of all practicing radiologists in the United States. These results showed that 54% of radiologists are in private practice and 46% are employed by various other entities. The current workforce consists of 21% general radiologists and 79% subspecialists. The largest areas of subspecialty include general interventionalists, neuroradiologists, and body imagers. In 2012, 1,407 radiologists were hired. The greatest number of radiologists hired involved general interventional radiologists, followed by general radiologists, body imagers, and those specializing in musculoskeletal radiology, neuroradiology, and breast imaging. In 2013, 1,526 job opportunities were projected and in 2016, 1,434 job opportunities. In 2013, the most sought-after individuals will be general radiologists, general interventionalists, breast imagers, neuroradiologists, musculoskeletal radiologists, and body imagers.

CONCLUSION

Based on the data collected from the responding practices, the demand for hiring radiologists in 2013 will be similar to 2012. Each of the 1,200 residents who complete their training programs each year should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires.

Visual search of experts in medical image reading: the effect of training, target prevalence, and expert knowledge

The aims of this study are (a) To determine the effect of training on the multiple-target lesion search performance; and (b) To examine the effect of target prevalence on the performance of radiologists and novices. We conducted four sessions of 500 trials in a lesion search on a medical image task in which participants searched for three different target lesions. Participants were 10 radiologists and novices. In each session, the prevalence of the different target lesions varied from low (2%) to high (40%). The sensitivity of novices was higher in the later sessions than in the first session, whereas there were no differences among sessions in radiologists. The improvement on sensitivity of novices was largely due to attenuations of false alarm (FA) errors. In addition, miss rates of the three targets did not differ in data of novices, whereas radiologists produced a higher miss rate for the highest prevalence target lesion (non-serious lesion) than for the other two lesions (serious lesions). The conclusions are (a) The training for the multiple-target lesion search task can be effective to reduce FA errors; and (b) The prevalence effect on lesion search can be attenuated by the multiple-target identification and the knowledge about seriousness of lesions. This suggests that acquired knowledge about normal cases and serious lesions is an important aspect of a radiologists' skill in searching for medical lesions and their high performance levels.

Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation

INTRODUCTION

Differences between radiologists and orthopaedic surgeons in the interpretation of MR images of the shoulder joint are experienced in daily clinical practice. This study set out to evaluate the inter-observer agreement between radiologists and orthopaedic surgeons in assessing pathology on MR imaging of the shoulder joint. Also, we determined the accuracy of the observers with arthroscopy as the standard of reference.

MATERIALS AND METHODS

Two radiologists and one orthopaedic surgeon reviewed 50 MR studies-25 conventional MR examinations and 25 MR arthrographies-of patients with shoulder complaints who had undergone MR imaging and subsequently arthroscopic surgery. The assessment was independent and blinded. All observers evaluated the MR examinations twice. Standard evaluation forms were used to score for pathology of rotator cuff, glenoid labrum, tendon of the long head of the biceps brachii and glenohumeral ligaments. The presence or absence of osteoarthritis, SLAP lesions, Bankart lesions, Hill-Sachs lesions or impingement was also noted. Intra- and inter-observer agreement, the sensitivity and specificity were calculated. Differences in percentages of correctly diagnosed lesions were tested for significance using McNemar's test.

RESULTS

There was a poor inter-observer agreement between the orthopaedic surgeon and the radiologists in assessing Bankart lesions and ligamentous lesions. We found significant differences between the radiologists and the orthopaedic surgeon in the assessment of osteoarthritis, Hill-Sachs lesions and impingement.

CONCLUSION

The orthopaedic surgeon and radiologists differed in their interpretation of what defines a Bankart lesion and what defines a ligamentous lesion. The orthopaedic surgeon was significantly more accurate in assessing impingement.