Radiology: A Serious Business


Welcome to Vox Percipio’s Weekly Dispatch newsletter. If you are receiving this first issue, then our paths have crossed during the 18 years that I have covered the field of radiology as a business journalist.

Today, I take the first step in a new direction: assisting radiology practices with internal and external communications. The Weekly Dispatch is my way of keeping in touch with the market by sharing concise readings of the week’s most important stories affecting the business of radiology.

This business of medicine is a deadly serious one. That fact was driven home last week in a broadcast on National Public Radio from the besieged city of Aleppo, Syria.

The reporter estimated that the number of physicians left in the city was 35. This, as well as a shortage of supplies and electricity, has put Aleppo’s physicians in the impossible position of rationing care, weighing the needs of the old against those of the young.

If a car doesn’t roll off the assembly line, then someone goes without transportation. If medical care is not available, then a man, woman, or child could be in mortal danger.

No Money, No Mission

People in the business of medicine have a favorite axiom: no money, no mission. With 10,000 baby boomers enrolling in Medicare each day and the uninsured down to 10% of the population, adequate resources are top of mind for policymakers and the nation’s largest payor.

Pressure on resources has been alleviated somewhat by the Affordable Care Act (ACA), according to the Center on Budget and Policy Priorities. It reported last summer that the 75-year shortfall in the Medicare Hospital Insurance Trust Fund, as a percentage of taxable payroll, was 3.88% before ACA (2009) and 0.73% after ACA (2016).

That projection, however, was based on the yet-to-be implemented changes in the physician-payment mechanism called for in the Medicare and CHIP Reauthorization Act (MACRA), enacted in April 2015 and due to launch as the Merit-based Incentive Payment System (MIPS) in 2017.

Expect a good deal of tinkering with the MIPS before we’re done. A blog post on the Health Affairs website dismissed the program as “an open invitation to game the system” due to its heavy reliance on self-reporting and the unlikelihood that HHS could come up with a reliable way to assign performance scores, in the face of so much variability.

The author urged clinicians to take advantage of CMS Acting Administrator Andrew Slavitt’s invitation to opt for partial participation, thereby delaying the full implementation of MACRA by one year.

Under the final rule to implement MACRA released today, 32.5% of all physician practices, including many radiology practices, will be exempt in 2017. The final rule exempts the more than 110,000 solo and small practices with 15 or fewer physicians billing equal to or less than $30,000 in Medicare Part B allowable charges or 100 or less Medicare patients.

As medicine begins the transition to value-based care, the specialty of radiology can and will continue to play an indispensable role in raising the quality of care and reducing its cost by seeking new ways to add value. If those improvements are not understood, however, they are unlikely to be valued.

I hope Vox Percipio’s Weekly Dispatch proves a valuable addition to your Friday inbox. To ensure its receipt, please add to your address book.

Cheryl Proval