Boston, July 2011
Dear fellow Massachusetts Radiological Society members,
Earlier this month I had the privilege to succeed Dr.John Dubrow as president of the society. The beginning of the new governance cycle offers an opportunity to review the issues the society is currently facing. I will certainly follow that time-honored tradition but first things first.
Thanks
I would like to express my sincerest thanks to our immediate past president Dr.John Dubrow for a phenomenal effort as our past leader. John has spent countless hours conducting the business of the society during a very busy year, which saw many unfavorable changes in reimbursement, some of which the society battled with some success, as well as much activity at the legislative front. As an astute participant in the political process, John tirelessly engaged with key lawmakers to make our message heard and has earned the respect of the governor and other key political figures in our state.
I would be remiss if I did not also acknowledge the dedication of the other current and former officers of the society as well as executive committee members, including but not limited to Drs.Shetty, Rogoff, Devlin, Norbash, and Semine. In times of rapid change, these individuals and others have to take time out from their respective practices in order to advocate on behalf of all of us when we meet with lawmakers, regulators, medical directors of private payers etc. Therefore, my sincere thanks also goes out to the many radiology and radiation oncology practices who make it possible for the MRS MD volunteers to work on behalf of the entire specialty. Lastly, I would like to thank our long-time chapter administrator Ginny DuLong for her diligent support and Mr.Ed Brennan, our legislative and legal counsel for his continued wisdom and tireless work at Beacon Hill on behalf of MRS.
Times of change
One thing is for sure: our healthcare delivery environment is rapidly changing. The unsustainable cost of healthcare in the US in general and our state in particular is the main catalyst of this change and provides a singular focus for government, private payors and patients. Unfortunately, the enormous success story of imaging which has led to the incorporation of one or several imaging tests into most episodes of care has not only endeared our workproduct to referring physicians and patients, but resulted in very high cumulative expenditure on imaging. In times when everyone is looking to curb cost, this has the imaging profession walking around with a proverbial giant target sign on its back. We are challenged to educate those who want to simply slash reimbursement for our services indiscriminately and across the board that
➢ imaging can save lives and reduce the need for exploratory surgery
➢ imaging can shorten expensive hospitalizations
➢ imaging helps make correct diagnoses resulting in more efficient and properly directed care
➢ volume of imaging performed by radiologists, a referral specialty, is not directly controlled by us
➢ there are evidence and expert consensus based tools available to accomplish rational utilization control (ACR Appropriateness Criteria ®)
While many of these points may seem familiar or self-evident to many of us, they are by no means entirely clear to those currently working to change the healthcare framework in an attempt to accomplish sustainability through delivery and payment reform. The MRS and also the American College of Radiology are working diligently to get this message out. Appropriate imaging provides tremendous value to healthcare delivery, needs to be appropriately reimbursed and is well positioned to enhance quality of healthcare which is so often cited as the parallel goal to cost savings these days. Anyone advocating for quality care at lower cost should consider the value of appropriate high quality imaging as an important tool to accomplish this worthy goal and work with radiologists to properly incorporate imaging into the new healthcare delivery paradigms.
Legislative Issues in MA
Recently, Governor Patrick proposed H.1849, “An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments”. Hearings ensued around the state, conducted by the new Joint Committee on Health Care Financing of the MA Legislature, co-chaired by Sen. Richard T. Moore of Uxbridge and Rep.Steven M Walsh of Lynn. The charge of the committee is to consider all matters concerning the direct funding of health care programs and any other Medicaid or public health assistance matters, fiscal matters relating to health care policy, Medicaid, MassHealth, the Uncompensated Care Pool and such other matters as may be referred. MRS Immediate Past President Dr.John Dubrow testified to the committee in Salem, MA, on behalf of MRS. Subsequently, written testimony was crafted by several members of the MRS Executive Committee and was submitted to the committee in late June 2011. The new standing committee on Government Relations of the MRS, co-chaired by Drs.Sanjay Shetty and David Rosman is in the process of setting up meeting times with key legislators for the months of July and August to present the viewpoints of MRS prior to the first round of drafting of a house version of the health care reform bill which is anticipated to be completed sometime in late Summer/early Fall.
I have asked the government relations committee to share the written MRS testimony with all MRS members in a dedicated communication so you may get a better understanding of which arguments were brought forward on your behalf. Any input and suggestions are welcome. The testimony is already available in the members-only section of our website www.massrad.org
Managed Care
I urge you to carefully read the managed care section of our MRS EC minutes. MRS has an active Managed Care and Carrier Advisory Committee, ably co-chaired by Drs.Rogoff and Waltman. Many unfavorable changes have come about, ranging from code bundling (CT Abdomena and Pelvis), to reductions in reimbursement for 3D postprocessing (Blue Cross Blue Shield of Massachusetts, BCBSMA), and, as the latest threat to fair payment, multiple procedure payment reductions for the professional component are being proposed not only by CMS but also all the major local private payers. MRS leadership is actively engaged with Medical Directors of payers to discuss those payment policy changes and is working hard to preserve the full professional component (PC) of reimbursement for multiple same day imaging procedures. However, this “fight” is not over yet, the current proposed CMS rule has recommended a reduction of the PC for multiple same day imaging procedures, following the recommendation of MedPAC, and against the mounting protest by the American College of Radiology (ACR), many other subspecialty societies, and despite increasing political support in Congress for preservation of the current arrangement. Arguments cited for a reduction of the PC in this situation are flawed, and your ACR leaders have been working hard to refute them by careful study of work associated with same day multiple imaging procedures. The findings of this study have been reported in the Journal of the American College of Radiology recently [Professional Component Payment Reductions for Diagnostic Imaging Examinations When More Than One Service Is Rendered by the Same Provider in the Same Session: An Analysis of Relevant Payment Policy Bibb Allen et al, JACR 29 June 2011 Article in Press DOI: 10.1016/j.jacr.2011.06.012]
Lastly, BCBSMA has recently announced a 13.5% reduction in the conversion factor for diagnostic imaging which will go into effect on September 1, 2011. MRS leaders including Drs.Wald, Rogoff, Patti and Ed Brennan recently met with senior BCBSMA directors and network administrators to discuss details of this impending change in payment which will be a hard hit to professional payments for radiologists in our state. Educating payers about the radiology profession and how radiologists performs their valuable work for which they need to be fairly compensated is an important task for MRS leaders which we take very seriously. While we may not be successful in changing payer policy we strive to keep the membership informed of such changes hopefully helping members to better manage adverse conditions. Our managed care committee co-chair Dr.Rogoff will soon provide an overview over this particular issue to members, stay tuned on this one.
Miscellaneous
MRS committee review
The committee structure and appointments of the MRS will be reviewed over the Summer and updates will be solicited from and approved by the executive committee. If you have been serving on any of the committees for a while we very much appreciate your service. Rest assured that your successors will take the service to the society just as serious as you did.
- Seminar for hospital based physicians:
We wish to share information about the following event with the membership because it may be of interest. This does not represent and endorsement of the content by the society. There will be a Health Management Associates (HMA) seminar for hospital based physicians around the issue of surviving in a new payment and practice world scheduled for Nov. 5, 2011. Break out sessions are targeted at each of the hospital based specialties including radiology. HMA provides services to a number of radiology practices, they have been a resource for MRS over the years in doing analysis of Medicaid fees used at hearings with the state as well as performing commercial insurance fee analysis useful to MRS.
- Staying up-to-date – visit MRS Website and subscribe to the MRS Twitter account
MRS has invested in a robust presence on the internet to keep its members informed. Details about the society, governance, calendar of activities as well as valuable members-only content about the ongoing healthcare reform effort, minutes of executive committee meetings and written testimony submitted to legislators are all available on www.massrad.org
Lately, relevant local and national developments pertinent to radiologists are being reported on the newsticker on our site through means of a dedicated twitter account. Consider subscribing to @massradsociety on Twitter to receive the latest updates and notification when new content has been posted in our members only section. It is easy to join the site if you are a member, directly on the site, and there is also information on how to join MRS if you have not done so.
Summary
In summary, these are times of rapid change. Your society leadership stands ready to tackle the challenge and represent radiologists in MA. You need to do your part by becoming a member of MRS and the American College of Radiology, at a minimum your membership dollars will be well used on behalf of our profession, helping to secure a bright future for Radiology. Preferably you decide to volunteer your time and help the society conduct its business. But regardless, now is not the time to sit back – join today, tell your colleagues who have not joined yet, sign up your practices. We need to stand together and be at the table when our future in context with healthcare reform is being decided, otherwise we will be “on the menu”.
Have a happy and healthy Summer,
Cheers
Christoph Wald, M.D. Ph.D.