President’s Message

August 2018

Dear Colleagues,

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, current issues facing our profession, and our goals as a leadership team for the year to come.

It is my privilege to succeed Dr. Bruce Stewart as the President of the MRS for the 2018-2019 term. I would like to extend my sincere appreciation to Dr. Stewart for his leadership, and to acknowledge his dedication and contributions to our community throughout his service.  I am grateful to have the support of a dedicated and talented team of volunteer leaders from radiology, radiation oncology, and medical physics, with the support and guidance of our national leadership at the American College of Radiology and our legal counsel Mr. Ed Brennan. Our society remains financially well positioned, with a positive balance. I would like to thank our Treasurer Dr. Priscilla Slanetz for her financial stewardship.  I would also like to acknowledge Dr. Rodrick Williams, who is now President Elect, our past Secretary Dr. Samuel Madoff, who is now Vice President, and Dr. Neel Madan who has taken on the role of Secretary. I also gratefully acknowledge the dedication of the members of our Resident and Fellow Section (RFS), led by Dr. Shahnaz Rahman as President during 2017-18, with Dr. Emmanuel Berchmans now taking over as President.  Please know that each of these individuals as well as all of the members of our Executive Committee spend hours of selfless time representing you, our constituency, on a variety of issues.

I would like to announce the news that our longtime chapter administrator, Ms. Virginia (Ginny) DuLong, retired from her position at the Massachusetts Medical Society (MMS) and with the MRS at the end of June.  Ginny has served as the chapter administrator for the MRS for the past 24 years and throughout this time has been absolutely instrumental to our Society, through her dedication, efficiency and knowledge of procedures and institutional memory.  We celebrated her retirement at our June meeting with heavy hearts, but with great gratitude and best wishes for her.  We are fortunate to have been paired with Ms. Lina Szymkowski as our new chapter administrator. Lina comes to us with extensive and impressive credentials and we are all excited to begin what we hope will be a long and productive collaboration with her.  Please join us in congratulating Ginny and welcoming Lina. 

The MRS is a volunteer organization whose key activities include educating and informing legislators, insurance companies/third party payers, and other stakeholders in the Commonwealth, about imaging, radiation oncology and medical physics.

Through this advocacy we hope to advance and support our ability to provide excellent care to our patients. We make every effort to be vigilant and active in legislative and informational efforts.

Below is a summary of current and upcoming issues:

MA Health Care Reform Legislation

House and Senate versions of a health care reform bill, H. 4639 and S. 2573, were separately passed by their respective chambers and referred to a House/Senate conference committee to reconcile the differences between the two versions. These bills were intensively considered by the conference committee but were unable to be reconciled prior to closure of the formal legislative session on July 31.  Therefore, no health care bill was passed in this session.  Nevertheless it is certain that these issues will be readdressed when the legislature reconvenes in January.   Key provisions within these bills that are of importance to radiology and radiation oncology included the following:

Out of Network Surprise Billing

This issue has received much attention this year, including by the Health Policy Commission (HPC), the Special Commission of Provider Price Variation, as well as the legislature.  The issue refers to the circumstance in which a patient receives medical services at an in network hospital, but ultimately receives a bill for services provided by an out of network provider as part of such care.  The specialties most commonly affected by these complex network relationships include Emergency Physicians, Radiologists, Anesthesiologists and Pathologists.  Good data do not exist as to the extent of OON surprise billing in the Commonwealth. Surrounding states including Connecticut and New York have passed laws regulating this practice including payment caps and balance billing prohibitions. Such billing may become more commonplace in the future with the proliferation of limited/narrow network plans offered by health insurers. The MRS has provided both verbal and written testimony on this issue, in support of a transparent system that ensures that both providers and patients are treated fairly, and in opposition to untenable patient notification requirements as well as an unprecedented rate setting role for the Health Policy Commission that was contained in the Senate bill.

Health Care Provider Scope of Practice

The Senate and House health care reform bills individually addressed issues of scope of practice for nonphysician health care providers.  The Senate bill would include expansion of scope of practice for a number of health providers including NPs and CRNAs, after 2 years of supervision by a physician or independent practice nurse. This expansion of scope of practice would include the ordering and interpretation of tests. The House healthcare reform bill would create a process through which a legislative committee that is acting on a scope of practice bill, would refer the issue to the Center for Health Information Analysis (CHIA) and the Health Policy Commission (HPC) for an external review of the issue, as well as hearings.  This review would result in a recommendation by these bodies, that the scope of practice proposal is considered positive, negative or neutral. The Legislative committee then would consider this nonbinding recommendation in decision-making regarding their recommendation to the Legislature. MRS provided testimony regarding these provisions at multiple stages of this legislative process, most recently with a letter to the conference committee considering both versions of the health care reform bill.  The testimony provided by MRS emphasizes the inappropriateness of inclusion of language allowing APRNs to “interpret” tests.  This could be construed as permitting interpretation of imaging examinations for which APRNs are not qualified by education or training.  We continue to strongly advocate that imaging interpretation should remain the purview of radiologists and other appropriately trained physicians. 

Funding of Community Hospitals through Assessment, Ambulatory/Office Based Surgical Center Taxation and Provider Fees

The health care reform bills contained provisions aimed at supplying additional funding to community hospitals.  Among these provisions were onetime assessments on large hospital systems and insurers; taxation of a new class of office based surgical centers and ambulatory surgery center, and increased medical licensure fees and surcharges for physicians and other health care providers.

The MA legislature was highly motivated to attempt to reconcile these disparate bills and pass a reconciled bill, but was unable to achieve consensus in this legislative session. The MRS among other physician organizations, was active in the process of advocating against multiple provisions in these bills, and we appreciate your participation in our call to action that occurred as part of this effort.  However it is certain that these issues will be readdressed when the legislature reconvenes.  As in the past we will continue to remain vigilant and advocate for the interests of our patients and our ability to provide quality care.  We will need your vigilance as well to let your voices be heard when called upon.  Please be on the lookout for future legislative updates.

Additional issues addressed by the MRS in the past year include the following:

Multiple Procedures Payment Reduction (MPPR)

The MPPR imposed by Medicare on the professional component on advanced imaging was reduced from 25% to 5% starting January 1, 2017, largely in part due to the tireless advocacy by the ACR to reverse this ill-informed policy. Since that time the MRS has worked with third party private payers in MA to encourage them to also eliminate and/or reduce their multiple procedure payment reductions such as to bring them in line with these federal changes, and continues to advocate for this policy change with payers who have not made this change.

Breast Tomosynthesis Reimbursement

Officers of the MRS and members of the Breast Imaging Committee have met in person with various payers to advocate for reimbursement for tomosynthesis. The increased cost and time of tomosynthesis, which is undertaken to provide improved patient care, needs to be supported financially. Our efforts have been largely successful, with the majority of MA payers now covering tomosynthesis, although we continue to advocate to secure universal coverage for this important technique.

Insurance Coverage for Tomosynthesis and Breast MRI

The MRS helped file legislation in the preceding year as sponsored by Senator Lovely to require state insurers to cover both screening and diagnostic tomosynthesis. 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. The MRS has joined with breast cancer patient advocates to encourage legislators to advance this life-saving legislation. The bill was referred to a study. We expect a bill to be refiled for the next legislative session.

ACR 2018 – Quality and Safety award

The MRS sponsored a large delegation of councilors/alternate councilors and trainees at the ACR’s annual meeting in Washington DC in May 2018. Highlights from the meeting included receiving an ACR Chapter Recognition Award for Quality and Safety; a testament to the strength of our chapter under the recent leadership of Dr. Bruce Stewart. This award was made possible in part by the contributions of Dr. Jennifer Broder, through her work with the MA Quality and Safety Council, as well as Dr. Lauren Ferrara and Dr. Kaushal Mehta, organizers of two consecutive RLI Leadership seminars sponsored by MRS in conjunction with the RLI.   Other highlights included the induction of two fellows from MA to become Fellows of the ACR (FACR). We also visited the offices of 11 legislators during our annual Capitol Hill Day including the offices of both of our Senators and all nine of our House Representatives. Pictures of our award and Capitol Hill Visit can be viewed at our website: http://massrad.org.

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. The MRS acknowledges that assisting trainees in our specialties to grow and develop their leadership skills is crucial to the future health of our field and of our patients.  To that end, the MRS is proud to be an ongoing sponsor of attendees to the RLI.  This year, as in years past, we are delighted to support the tuition of four trainees to attend the annual RLI Leadership Summit, to be held September 7-9, 2018 at Babson College.

Please know that all MRS members including residents and fellows are eligible to receive a discount for the 2018 RLI Summit by registering at  https://www.acr.org/Practice-Management-Quality-Informatics/Radiology-Leadership-Institute/Programs-and-Training/Leadership-Summit

Residents and fellows should use code RLIMIT15 to receive a 15% discount and MRS members should use RLICHAP500 to save $500 during checkout.  In addition, MRS members, through a supporting arrangement with the RLI, are also granted access to one RLI webinar.  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/

During the past year, the MRS in conjunction with the RLI once again sponsored a very well received one day course prior to the RLI Summit which was tailored for earlier levels of radiology leadership, particularly trainees and younger radiologists. The “2nd Annual Massachusetts Radiological Society Leadership Symposium” organized by Dr. Kaushal Mehta and Dr. Lauren Ferrara was held at the Massachusetts Medical Society in Waltham, MA on Wednesday, September 6th, 2017.  This event was very well attended and received excellent reviews.

Committee on Diversity

Recognizing the important role of supporting and facilitating diversity in radiological care, the MRS is proud to announce that we have initiated a new Committee on Diversity which will report to the EC.  The Committee’s inaugural chairperson is Dr. Rodrick Williams.  We are currently seeking interested volunteers for service and participation on our Committee on Diversity.  Please let us hear from you with your insight, challenges and perspectives that can inform the Committee’s understanding of issues of diversity in our community of MA radiology, radiation oncology and medical physics.

MRS Annual Meeting

Mark your calendars for the MRS Annual Meeting which will be held on Wednesday, March 27, 2019 at the headquarters of the Massachusetts Medical Society in Waltham MA. Our guest speaker will be Dr. Eliot Siegel, FACR, FSIIM, Professor and Vice Chair at the University of Maryland School of Medicine, Department of Diagnostic Radiology, as well as Chief of Radiology and Nuclear Medicine for the Veterans Affairs Maryland Healthcare System.  Dr. Siegel was responsible for the NCI’s National Cancer Image Archive and served as Workspace Lead of the National Cancer Institute’s caBIG In Vivo Imaging Workspace.  A thought leader in IT in Radiology, Dr. Siegel will address us on the current and future role and impact of AI/Machine learning in Radiology.

Conclusion

In summary, the rapid pace of change continues for both radiology and healthcare in general. The MRS remains committed to monitoring developments at the local and state level and advocating on behalf of our patients and our profession. Our executive committee is honored to serve you, our dedicated members, whose continued membership and support make it possible for us to pursue the missions of our society.

I wish you the best for an enjoyable and meaningful upcoming year.

Sincerely,

Maryellen R. M. Sun, MD
President