Physician Reimbursement

 

Radiologists cannot ignore the evolving standards for determining physician reimbursement in the U.S. The nation cannot control runaway medical spending without fundamentally changing how physicians are paid. This realization has led to a payment policy paradigm shift from fee-for-service to fee-for-value.

Radiologists must begin highlighting and implementing best practices, particularly in common high impact tasks, such as creating meaningful and actionable reports and communicating with physicians. The Affordable Care Act (ACA) will fundamentally change the reimbursement paradigm for the provision of medical care in the United States, creating regulations and market forces, which will move us away from the traditional fee for service model.

As reimbursement evolves to reward patient outcomes, best practices, and evidence based utilization of medical resources including radiology services, radiologists will be increasingly involved in managing the appropriate utilization of medical imaging with their clinical colleagues.

The so-called fee-for service model of the past, in theory will become a fee-for value model, states Shawn Fibkins, MD Vice President of SteleRAD. “As we have for the past 40 years, SteleRAD remains committed to providing the highest level of radiology services to our patients.” No matter what changes the ACA may have on the reimbursement model of the medical profession, our radiologists will continue to provide our subspecialty expertise interpreting imaging examinations and performing interventional procedures. We remain physicians first, who are completely committed to caring for our patients.”

How is the Affordable Healthcare Act Going to Impact Radiology?

As with every other physician in the country, the radiologists at SteleRAD are being proactive in preparing for the changes in Medicare reimbursements being brought upon by the ACA. One of the major components being driven by the measure is the formation of healthcare organizations called Accountable Care Organizations (ACO). ACOs are healthcare organizations that are created to coordinate and provide medical care to groups of over 5,000 Medicare beneficiaries. It is imperative upon all radiologists to know their place as a central component of health care and take their rightful place among these newly created ACOs and be compensated accordingly.

Radiologists often play a central role in the overall care of a patient. Radiologists often discuss radiological results with several groups of individuals such as oncologists, pathologists, surgeons, and primary care physicians in an attempt to administer the proper and most effective medical treatment for the patient; therefore, radiologists are the central figure in determining the proper course of treatment for the patient.

How Radiologists Can Make Their Case as Primary Care Givers

In order for radiologists to claim their rightful place among the ACOs, they must be willing to change a few aspects of the manner in which they practice. The radiologists at SteleRAD are active participants in caring for our patients, communicating with referring physicians and aligning SteleRAD’s interests with the hospital administration we work with.
One way in which to do this is to become members of hospital committees that are not solely devoted to the practice of radiology, but are devoted to overall patient care and the creation of policies of the health care organization. Becoming members of these committees allows the voice of radiology to be heard and assists in building stronger relationships throughout the medical facility. In addition, our board certified radiologists must also become members of the state’s medical society.

Promote Clinical Decision Support Software

Radiologists can further prove their value to ACOs by promoting the use of clinical decision support software. Clinical decision support software, such as the one created by the American College of Radiology called ACR Select, determines the appropriateness criteria for all radiological exams ordered by any physician in the hospital enterprise and gives immediate feedback on whether the exam that was ordered is appropriate or not.

Through the support of this clinical initiative, radiologists, like the physicians at SteleRAD, also make ourselves peer-to-peer consultants because we will ultimately be consulted if a study ordered by another physician does not meet appropriateness criteria. Furthermore, the implementation of clinical decision support software will help drive down the cost of imaging services and the overall cost of healthcare which will end up being more lucrative for the primary care givers like radiologists.

If you are looking for state-of-the-art radiological services for your medical center or hospital, look no further than SteleRAD. Our experienced radiologists provide quality care in Palm Beach, Broward, and Miami-Dade counties. Contact us online or call us at 954-358-5250 today.