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Stephen O'Connor

By: Stephen O'Connor on January 6th, 2017

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What MACRA Means for Your Radiology Practice

Radiology Information System | Value-Based Care

When tax dollars are fed into the healthcare system, taxpayers will naturally have a vested interest in seeing costs lowered and efficiency improved. From family doctors to specialists of all types, there is a move toward promoting quality of care over quantity of care.

All of the patients that you treat in your radiology practice that happen to get their health insurance through Medicare are leading to claims with fees for service that the government is now taking a major interest in streamlining. To that end, congress passed the Medicare Access & Chip Reauthorization Act of 2015, commonly referred to as MACRA.

The Department of Health and Human Services will be asking radiology practices to report back to the government how they are working to use less resources while giving patients better treatment and outcomes.

Ensure your practice is properly prepared for MACRA. Billions of dollars can be saved by focusing on quality of care rather than quantity.

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What Exactly Is MACRA?

MACRA signals a transition from the older model of fee for services to a new model based on quality of treatment. The HHS seeks to replace the patchwork of programs now being used to report on the quality levels of care they provide to Medicare patients. Congressional passage of MACRA highlights the legislature’s desire to develop a single framework for quality reporting. This is known as the MACRA Quality Payment Program (QPP).

Owners, managers, and other primary stakeholders in radiology practices must recognize the importance of being knowledgeable about MACRA. Failure to take MACRA into account could mean that you will see a decline in revenue. Other radiology practices that address MACRA and comply with its reporting requirements will be eligible to receive financial incentives from the government. This will make them even more competitive with your practice.

Most Radiologists Will Participate in MACRA through MIPS

The majority of radiologists will start participating in MACRA by using the Merit-based Incentive Payment System. MIPS covers four discrete performance categories for physicians. It is based on 100 points that are awarded in these categories:

  • Advancing Care Information
    • This accounts for 25 points and replaces the Meaningful Use program.
  • Clinical Practice Improvement Activities
    • Accounting for 15 points, this category focuses on patient safety and coordinating care.
  • Cost
    • Demonstrating improvements in cost can amount to as many as 10 points and this eliminates the formerly used Value-based Payment Modifier or VBPM cost component.
  • Quality
    • The most important criteria, this accounts for 50 points. It replaces the quality component of the VBPM and eliminates the previous Physician Quality Reporting System.

MACRA Specifics to Radiology

You’ll need to become familiar with the financial aspects of MACRA and how they relate to your radiology practice. Under MACRA, the expected revenue and adjustments are as follows:

  • Approximately 50,770 clinicians will be involved.
  • Positive payment adjustment will be 68.4%, or $131 million.
  • Negative payment adjustment will be 31.6%, or $12 million.
  • The average for a 10-physician radiology practice will be about $50,195 during the first year of participation.

Radiology Specialty Measures

The latest version of MACRA accounts for 22 different specialty measures your radiology practice can work with. You only need to pick a total of six out of the following three categories covering 22 options:

  • 15 Process Measures for Effective Clinical Care
  • 4 Structure Measures for Care Coordination
  • 3 Outcome Measures for Patient Safety

Radiology – Future Cumulative Payments and Penalties

Looking forward to the years 2019-2022 and beyond, keep in mind that based on the reported performance of eligible clinicians, practitioners and doctors can receive cumulative positive or negative payment adjustments.

This underscores the need for your team to become proficient at the new reporting requirements as soon as possible, to avoid delays in your revenue cycle. You may find it best to hire consultants to help train members of your team, allocating plenty of staff time and resources to becoming more proficient in quality reporting.

Things Radiologists Can Do to Prepare

Given the importance of MACRA in terms of the bottom line for your radiology practice, you’ll want to begin taking steps to prepare for the change. According to a recent article at AuntMinnie, there are three main actions that radiologists can take to get ready for this major change in the healthcare industry:

1. Sign up for and participate in the National Radiology Data Registry. The NRDR was established by the American College of Radiology to help radiology practices improve the way they care for patients, by letting them share and compare data pertaining to treatment in their particular region.

You’ll have your choice of eight different registries and can sign up with one or all.

2. Take advantage of the Radiology Support, Communications and Alignment Network, also known as R-SCAN. This network is maintained by the ACR and is funded by a grant from the HHS to support the Transforming Clinical Practices Initiative.

With R-SCAN, radiologists in disparate locations can join forces and become collaborators with fellow clinicians. They can help one another with making clinical decisions and improving their imaging techniques. The more information they can exchange through this network, the better these clinicians can serve their patients.

3. Work out the costs involved by using ICE-T, the Inpatient Cost Evaluation Tool, which was developed at the ACR’s Harvey L. Neiman Health Policy Institute. With more bundled payments anticipated for radiology services along with changes in the alternative payment models, you’ll want to get a better handle on the costs involved for these services.

Getting your radiology practice prepared for MACRA is of paramount importance. The more patients you treat who are covered by Medicare, the more your physicians will need to demonstrate quality of care for them.

Key Takeaway:

  • Congress passed the Medicare Access & Chip Reauthorization Act of 2015 to encourage quality of care over quantity of care.
  • MACRA will be supported by a streamlined method of reporting called the MACRA Quality Payment Program.
  • Radiology practices need to prepare themselves for MACRA and quality performance requirements in order to get properly reimbursed for treating Medicare patients.
  • Begin preparation by participating in the National Radiology Data Registry, as administered by the American College of Radiology.
  • Sign up with the Radiology Support, Communications and Alignment Network. R-SCAN helps you connect with other clinicians to share information about improving patient care.
  • Get a better handle on costs by using ACR’s Inpatient Cost Evaluation Tool.

How are you preparing for MACRA? Comment below to let us know! And to help your organization gear up for the transition and its healthcare quality reporting requirements, we’ve developed an informative document that you can download free of charge now. Click here to access our “MACRA: How to Prepare for Tomorrow’s Healthcare Industry” ebook.


About Stephen O'Connor

Stephen O'Connor is the Director of Brand and Digital Marketing, responsible for many aspects of Advanced Data Systems Corporation’s (ADS) marketing, including product marketing, customer acquisition, demand generation, brand, brand design, and content marketing.

Stephen has more than 20 years of healthcare industry experience. Prior to ADS, Stephen spent 11 years at Medical Resources Inc. (MRI), most recently as the Manager of Marketing & Internet Services, where he and his teams were responsible for all marketing efforts and the market positioning of MRI’s services.

Stephen spends his day's planning, writing, & designing resources for the modern healthcare professional.