President’s Message

January 2018

Dear Colleagues,

On behalf of the Officers and Executive Committee of the MRS, I would like to update you regarding the activities of the society as part of the annual president’s report.

I continue to be grateful to have the support of a dedicated and talented team of volunteer leaders drawn from radiology, radiation oncology, and medical physics. I would like to acknowledge the generous help of Dr. Deborah Levine, Past President; Dr. Maryellen Sun, President Elect; Dr. Rodrick Williams, Vice President; Dr. Samuel Madoff, Secretary and Dr. Priscilla Slanetz, treasurer. Our society is supported by lobbyist and legal counsel Mr. Ed Brennan with his unique talents in navigating the legislative landscape and our chapter administrator Ms. Ginny DuLong with assistance from Mr. Miguel Ocque who help maintain the seamless function of the society. I would also like to thank Dr. Neel Madan for his supporting the MRS website and our current Resident Fellow Section (RFS) president Dr. Shahnaz Rahman for her work maintaining a vibrant section for our trainees. The members of our Executive Committee and the above officers spend hours of selfless time representing you, our constituency, on a variety of issues.

Our Massachusetts chapter continues to be well represented at the highest levels in the American College of Radiology (ACR) leadership. We have many members involved as both chairs and members of ACR committees that are too numerous to mention individually here. I would, however, like to acknowledge those members serving within the Board of Chancellors and Council Steering Committee including Dr. James Brink, Chair of the ACR Board of Chancellors; Dr. Keith Dreyer, Board of Chancellors, Chair of the Commission on Informatics; Dr. Jonathan Kruskal, Board of Chancellors and Chair of the ACR Intersociety Commission and Dr. McKinley Glover IV, Council Steering Committee and Council Steering Committee representative to our MRS state chapter.

Chapter Update

At present, membership in the MRS remains stable with 1247 members, consisting of radiologists, radiation oncologists and physicists including members-in-training. This affords Massachusetts an allocation of 13 Councilors and 14 Alternate Councilors (including a Young Physician Alternate Councilor) ensuring a strong attendance at our chapter executive committee meetings and at the ACR annual meeting in Washington, DC each spring. As always, we would like to encourage even more membership, so please reach out to your colleagues and encourage them to join (or rejoin) the MRS and the ACR. In recent years, the MRS has been proactive in ensuring that a large contingency of residents attends the ACR Annual Meeting as sponsored by a combination of ACR, MRS, and residency training program funding. The net result has been a substantial Massachusetts representation at the ACR Annual Meeting.On behalf of the Massachusetts Radiological Society (MRS) Officers and Executive Committee, I would like to update you regarding our activities over the past year, the most pressing issues facing our profession, and our goals as a leadership team for the upcoming year.

A Summary of Current and Future Key Issues:

Advanced Practice Nursing (APN) Expanded Scope of Practice

The MRS continues to be vocal in our concerns regarding nurses practicing without physician oversight. I provided in person testimony in November to the Joint Committee on Public Health against H. 2451 and S. 1257, House and Senate bills which would grant independent practice to Nurse Practitioners (NPs). We remain particularly strongly opposed to language in those bills
expanding nurse scope of practice to include the interpretation of tests, which could include imaging exams. We continue to strongly advocate that imaging interpretation should remain the purview of radiologists and other appropriately trained physicians.

Perhaps more concerning, however, is an omnibus health care bill passed by the Senate in November which includes a myriad of changes as originally proposed by the Special Senate Committee on Health Care Reform. This bill includes increased scope of practice for midlevel practitioners including independent practice for all APNs including NPs after two years clinical supervision by a physician or independent nurse. The language in the bill for APNs includes “ordering and interpreting tests,” which could be construed to allow interpretation of medical tests such as imaging exams. The critical question is how many, if any, of the Senate proposals including expanded APN scope of practice the House will take up in its sessions in the winter/spring of 2018. We will be vigilant regarding the activities of the House in relations to this and any other proposals that may affect our patients and our specialties.

Out of Network Surprise Billing

As I discussed in my summer letter, an issue that continues to receive attention is out of network (OON) surprise billing in which a patient may receive a bill for medical services provided at an in network hospital by an out of network provider such as a radiologist. This issue has been a focus of the Health Policy Commission (HPC), the Special Commission of Provider Price Variation and the legislature. Good data do not exist as to the extent of OON surprise billing in the Commonwealth but such billing may become more commonplace in the future with the proliferation of limited/narrow network plans offered by health insurers. Included in the omnibus healthcare bill passed in the Senate in November is a provision on OON billing. From July 2018 to January 2020 a rate would be set by the state for OON providers at a level not to exceed the 80th percentile of an independent data agency such as FAIR Health. Starting in 2020 the HPC, after a hearing, would make a recommendation for an OON rate to the Commissioner of Insurance who would have authority to set a rate, after a hearing, to be effective for five years. Every five years there would be a similar process. The MRS and other state medical societies are strongly opposed to this provision for several reasons including the unfair expansion of the HPC authority to set rates for providers but not insurers. We are also opposed to the unworkable burden of insurance disclosure on the provider and the lack of independent dispute resolution. The MRS will closely follow the House in the winter/spring of 2018 to see if it will take up the OON billing issue and if it will adopt the Senate’s
or another approach to OON billing.

Legislation to Ensure Insurance Coverage for Tomosynthesis and Breast MRI

As discussed in my summer letter, the MRS helped Senator Lovely file legislation in early 2017 to require state insurers to cover both screening and diagnostic digital breast tomosynthesis (DBT). The same bill would also require insurance coverage for additional imaging such as ultrasound or breast MRI in patients with dense breast tissue or who have additional breast cancer risk factors. All coverage would not be subject to patient cost sharing such as co-pays or deductibles. Dr. Priscilla Slanetz, Dr. Rodrick Williams and Dr. Amy Patel represented the MRS in providing in person testimony to the Joint Committee on Financial Services in support of H. 2176 and S. 544 during a hearing in October. The MRS has also worked with breast cancer patient advocates to encourage legislators to advance this life-saving legislation.

Digital Mammography and Breast Tomosynthesis Reimbursement

Officers of the MRS and members of the Breast Imaging Committee have met in person on multiple occasions in recent years to advocate and lobby MA third party payers to reimburse for DBT. This advocacy, as spearheaded by Dr. Philip Rogoff, helped to convince Harvard Pilgrim Health Care to cover both screening and diagnostic DBT as announced in November to become effective January 1, 2018. It is gratifying that HPHC and other insurers have recognized the value of DBT in improving patient care and a testament to the persistence of MRS advocacy. I want to express deep gratitude to Dr. Rogoff who represents our constituency so well and proactively in managed care issues. Please see his Managed Care Committee report in our annual meeting booklet for his summary of these issues. One issue of concern is Blue Cross Blue Shield of Massachusetts (BCBSMA) 40% reimbursement cut for the technical component of digital mammography performed inthe outpatient setting which became effective in January 1, 2017. The MRS continues to seek a meeting with BCBS-MA to understand its justification of such a deep and arbitrary reimbursement reduction that significantly threatens patient access to breast imaging services provided in freestanding mammography facilities.

Low Dose CT Lung Cancer Screening

Dr. Andrea McKee continues to lead an effort to develop a consortium of imaging groups who provide CT lung cancer screening in Massachusetts. The goal is to standardize methodologies and to learn from each other’s experience in order to improve quality and patient experience. To this end, the MRS has worked with Dr. McKee and the Department of Public Health to develop a survey of CT lung cancer screening programs in the Commonwealth that has yielded valuable data and best practices that will be shared.

Center for Health Information (CHIA)’s Consumer Health Care Transparency Website

CHIA, an independent MA agency generating health care data and analytics, is developing a transparency website mandated by law to provide decision aids and cost/quality information related to health care procedures including many imaging exams and procedures. The MRS has worked with CHIA in both developing the consumer decision aids and reviewing its cost methodologies. We will be providing feedback on the beta website before it is expected to go live broadly to the public in 2018.

Imaging 3.0

We often discuss about how to improve the “Face of Radiology.” The ACR Imaging 3.0 initiative encourages us to make a concerted effort to emerge from our reading rooms and actively interact with our patients, non-radiologists colleagues, administrators and technical staff to collectively create and sustain best practices for imaging. By working together with other specialties and within our own imaging community we can best achieve optimal patient care while preserving our specialty. Dr. Jennifer Broder and Dr. Lauren Ferrara helped to put Imaging 3.0 into action for the second year in a row at the annual ACR meeting in May 2017. They continued to lead a program where MA radiology residents/fellows attending ACR 2017 were paired with radiology councilors/alternate councilors to develop Imaging 3.0 projects to bring back to their host
institutions.

Radiology Leadership Institute (RLI)

The RLI was created by the ACR as a resource to facilitate leadership training across the full spectrum of radiology trainees and practitioners. Massachusetts continues to play a prominent role in the activities of the RLI not only as RLI leaders and educators but also as students and participants. MRS members, through a supporting arrangement with the RLI, are provided access to one RLI webinar at no charge. If you would like to view the potential webinar options and make your selection, please use the following hyperlink: https://radiologyleaders.wufoo.com/forms/m3pv2u300iznyt/. For the second year in a row, the MRS in conjunction with the RLI sponsored an exciting one-day course tailored for earlier levels of radiology leadership, particularly trainees and younger radiologists. The “Second Annual Massachusetts Radiological Society Leadership Symposium” organized by Dr. Kaushal Mehta and Dr. Lauren Ferrara was held in early September prior to the annual RLI Summit at the Massachusetts Medical Society in Waltham, MA. The Symposium was well attended by both attending radiologists and trainees from across the state that shared favorable feedback.

MRS Annual Meeting

Please come join us for the MRS Annual Meeting that will be held on the evening of Wednesday, March 7, 2018 at the headquarters of the Massachusetts Medical Society in Waltham, MA. Our guest speaker will be Dr. Ezequiel “Zeke” Silva, III who is Chair of the ACR Commission on Economics, a practicing interventional radiologist and an internationally recognized expert in payment policy and quality initiatives. He will be speaking on “How Lessons Learned in Massachusetts Translate Across the US” which promises to be a dynamic, relevant and interactive talk. Please see the attached brochure for further details and registration information.

Conclusion

As is clear from this report, 2017 has been an active year with many issues that can and will impact the practice of radiology and radiation oncology in Massachusetts. The economics of healthcare globally and radiology/radiation oncology more specifically continue to rapidly evolve. The support and participation of our members remains critical to ensuring that our voices are heard in this dynamic landscape. If you have observed on the sidelines in the past, I encourage you to become involved to ensure the vibrancy of our specialties and our practices. As the transition from fee-forservice to more merit and value based reimbursement continues, the MRS will continue to educate its members regarding the value of the principles of Imaging 3.0 and the importance of radiologists’ active involvement in their health care organizations as shared payment models are developed and implemented.

Thank you for the continued honor to serve you as the president of the Massachusetts Radiological Society (MRS) for the 2017/2018 year. I am indebted to the many selfless volunteers who serve the society who seek to improve our profession and the lives of our patients. The MRS will continue to monitor state and local developments, advocate on key issues and communicate pressing issues to our membership. Despite the many challenges we face, I remain optimistic about our future moving
forward.

I wish you all the best in 2018.

Sincerely,

Bruce G. Stewart, MD
President