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1 No conflicts of Interest to Disclose
2 Bird s eye view of some of the ACR initiatives Value-added to Radiology, Pediatric Radiology, Patient care Activities of Pediatric Commission
3 Pediatric Commission Safety & Quality Marilyn Goske, Jonathan Dillman Education Dorothy Bulas, Diego Jaramillo Standards & Guidelines Eric Faerber Economics Richard Barth, Richard Benator Advocacy Stuart Royal Research Heike Daldrupiink, Steve Voss CR-DR Steering Committee AMCLC 2015 SPR Pediatric Content 13 new collaborative guidelines in process SPR 2014 Capitol Hill visits Mission statement Website Pediatric Radiology journal Accreditation AdHoc Pediatric MR Subcommittee AdHoc Subcommittee Joint educational undertakings
4 Founded 1923 Radiologists, Radiation oncologists, medical physicists 400+ staff in Reston VA Main headquarters Education Center Washington DC - Advocacy Silver Spring MD - AIRP Philadelphia PA ACRIN Research
5 ACR Pillars
6 QUALITY & SAFETY MIPPA (Medicare Improvements for Patients and Providers Act) 2008 Starting January 2012 Required accreditation for NM, CT, MR (in addition to mammography already in place) Accreditation new baseline for perceived VALUE 6
7 QUALITY & SAFETY
8 QUALITY & SAFETY
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10 QUALITY & SAFETY Pediatric Commission Pediatric Practices Adult criteria, adult studies AdHoc Pediatric MRI subcommittee Cynthia Rigsby Ashok Panigraphy Sudha Anupindi Hermann Kan Seraj Surai (physicist) Safety & Quality Marilyn Goske, Jonathan Dillman Accreditation AdHoc Pediatric MR Subcommittee
11 QUALITY & SAFETY Over 500 registered facilities 11
12 QUALITY & SAFETY Six Children s Hospitals Optimal CT scan techniques Optimal dose indices 12
13 QUALITY & SAFETY
14 QUALITY & SAFETY Subcommittee on Pediatric Digital Radiography Techniques Steve Don, Robert Mac Dougall Pediatric Commission Safety & Quality Marilyn Goske, Jonathan Dillman CR/ DR techniques in pediatric hospitals vary 28-fold Much more than can be accounted for by type of detector or the use of grids staff at hospitals not sure of what type of equipment they had, or how to use it CR-DR Steering Committee 14
15 QUALITY & SAFETY Purpose Establish guidelines for hospitals to develop pediatric technique charts for DR Representatives from stake holders ACR, SPR, Image Gently, AAPM, ASRT, MITA, FDA Pediatric Commission Safety & Quality Marilyn Goske, Jonathan Dillman CR-DR Steering Committee WHITE PAPER 15
16 QUALITY & SAFETY 22 Practice Parameters cosponsored by SPR in 2015 Committee chose to cosponsor 22 Practice Parameters for 2016 Pediatric Commission Standards & Guidelines Eric Faerber 13 new collaborative guidelines in process 16
17 QUALITY & SAFETY ACR Guidance Document on MR Safe Practices: 2013 Rad-Peer Rad-Peer as PQI Bi-Rads ACR Manual on Contrast Media RadiologyInfo.org 17
18 EDUCATION ACR Education Center Online learning Print learning materials Multimedia instructional materials Off-site educational meetings CME e.g., Case-in-Point AIRP American Institute for Radiologic Pathology RLI Radiology Leadership Institute 18
19 EDUCATION Pediatric Commission AMCLC 2015 A meeting for all members SPR sponsored session Geared towards adult radiologists Advocacy/Economics emphasis Keynote: General Colin Powell Ad-Hoc joint ACR-SPR committee Needs assessment currently in progress Education Dorothy Bulas, Diego Jaramillo AMCLC 2015 SPR Pediatric Content AdHoc Committee Joint educational undertakings 19
20 EDUCATION ACR Education Center Courses Congenital heart disease MSK MR CT Colonography Neuroradiology Head and Neck 20
21 EDUCATION A four-week Radiologic Pathology Correlation Course Radiology residents, fellows and practicing radiologists State-of-the-art, at the AFI Silver Theatre and Cultural Center in Silver Spring, MD airp.org 21
22 EDUCATION 22
23 RESEARCH Clinical Research Neiman Health Policy Institute 23
24 RESEARCH ACRIN - ACR Imaging Network completed first decade Greater than 30 clinical trials greater than 100 imaging facilities Imaging clinical trials 24
25 RESEARCH ACRIN - ACR > 90 publications 25
26 RESEARCH Pediatric Commission Visited ACRIN center Philadelphia Identified research priorities priority leaders multicenter research initiatives White Paper Funding Sources Research Heike Daldrupiink, Steve Voss Mission statement Website Pediatric Radiology journal 26
27 Research 27
28 RESEARCH Only invited articles Selective journal with many excellent submissions White papers Economics Politics Quality, Safety Managed care Regulation Accreditation CME 28
29 ADVOCACY The ACR Government Relations Team
30 ADVOCACY ACR monitors, engages and liaisons with all federal agencies, rulemakings, and initiatives relevant to radiology, including (but not limited to): U.S. Food and Drug Administration (FDA) National Institutes of Health (NIH) Nuclear Regulatory Commission (NRC) U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (HIT) Agency for Healthcare Research and Quality White House Office of Science and Technology Policy U.S. Access Board 30
31 ADVOCACY Relative Value Update Committee (RUC) meets three times/yr ACR representation on RUC panel Codes presented at RUC arise from CPT or at request of CMS CMS historically accepted >90% of RUC recommendations this has changed Arbitrary reductions of work and practice expense Refinement panel access limited Final values are published in the Medicare Physician Fee Schedule (MPFS) final rule 31
32 Protecting Access to Medicare Act of 2014: HR4302 April 2014 SGR (Sustainable Growth Rate) patch SGR Repeal and Medicare Provider Payment Modernization Act Avoid the 24% across-the-board cut mandated by SGR - BBAct (1997) Mandates that any cuts >20% be phased in over 2 years Require CMS to produce data to justify MPPR payment reductions including those instituted in 2012
33 Protecting Access to Medicare Act of 2014: HR4302 April 2014 SGR (Sustainable Growth Rate) patch SGR Repeal and Medicare Provider Payment Modernization Act Requesting physicians must CONSULT evidence or expert consensus criteria before requesting advanced imaging CT, MRI, Nuclear Medicine Will obviate use of RBM s (Radiology Benefit Managers) Nov 15, 2015: HHS secretary has authority to specify accepted AC April 1, 2016: the list must be published January 1, 2017: Requesting MD must have consulted the guidelines to receive payment January 1, 2020: Outlier MD s will be subjected to prior authorization CT scanners must meet NEMA standards limiting radiation dose Currently XR % reduction in 2016; 15% in 2016
34 QUALITY & SAFETY Expert Panel Literature search Evidence-based Ratings on strength of the existing, published evidence Brian Coley: Body, Neuro 34
35 QUALITY & SAFETY CDS Integrates evidence-based appropriateness criteria into the requisition-generating system Where appropriateness criteria or published evidence are not available, these will be based on expert consensus uses Electronic Health Record (EHR) Utilization Review and QI Will obviate need for RBM pre-authorization Expedite reimbursement process ECONOMICS acrselect.org 35
36 IMAGING 3.0 ECONOMICS ECONOMICS 36
37 ADVOCACY Ophthalmologits Ophthalmologis ts Rep. Phil Gingrey, MD Rep Phil Gingrey MD (ObGyn) ACR CEO Harvey L. Neiman, MD, FACR Psychiatric Assn. Psychiatric Assn Surgeons Surgeons Anesthesiologists Anesthesiologis ts Pathologists s 37
38 VALUE : VALUE DUES < $20 per week TC- MPPR kept at 25% from 50% PC-MPPR reduced from 50% to 25% Assume 30% of CT exams are 2 nd or 3 rd exam Assume 25 CT exams per scanner per day, 250 d/yr (weekdays only!) Use MFS TC reimbursement $352,500 additional revenue per CT scanner not lost
39 ADVOCACY Extensive coding education for ACR members Clinical Examples in Radiology ACR Radiology Coding Source newsletter Coding guides Ultrasound, Nuclear Medicine Coding update Interventional Radiology ICD-10 Physician Documentation Improvement Training Podcast series Available now online Series of 20 MP4 podcasts 5 7 minute video & audio Learn more at acr.org/billingcoding 39
40 Complimentary subscriptions to leading publications: 1. Journal of the American College of Radiology 2. ACR Bulletin 3. ACR Radiology Coding Source Member discounts on continuing education ACR Continuous Professional Improvement (CPI) for AMA PRA Category 1 Credit and SAM credit ACR Learning File and Mammography Case Review Membership complimentary residents; discounted early career 40
41 Free or deep discounts on CME/MOC activities covering subspecialties across the radiology specialty spectrum:» Daily Case in Point» Child-sizing CT Dose» Image Wisely Radiation Safety Case» JACR journal-based CME activities Live education meetings, ranging from clinical issues to daily business requirements of radiology practice Nonclinical courses to help radiologists in all career stages 41
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