Health Policy

Caught Between a Radiation Oncology Case Rate (ROCR) and a Hard Place: Improving Proposed Radiation Oncology Alternative Payment Models

The Radiation Oncology Case Rate (ROCR) aims to shift radiation reimbursement from fee-for-service (FFS) to bundled payments, which would decouple fractionation from reimbursement in the United States. This study compares historical reimbursement rates from 3 large centers and a national Medicare sample with proposed base rates from ROCR. It also tests the impact of methodological inclusion of treatment and disease characteristics to determine if any variables are associated with greater rate differences that may lead to inequitable reimbursement. Full Article

Aaron Bush, MD, Chi-Mei Liu, PhD, Elizabeth Y. Rula, PhD, Join Luh, MD, Nathan Y. Yu, MD, Nadia Laack, MD, Albert Attia, MD, and Mark Waddle, MD. 2024. "Caught Between a Radiation Oncology Case Rate (ROCR) and a Hard Place: Improving Proposed Radiation Oncology Alternative Payment Models," International Journal of Radiation Oncology, Biology, Physics

Medicare Volume Growth and Shift in Payments From Physicians to Non-Physician Practitioners Under Statutory Budget Neutrality

Volume increases, inflation, statutory freezes in physician payments, and the budget neutrality requirement for the Medicare Physician Fee Schedule have resulted in persistent inflation-adjusted conversion factor decreases. This study aimed to determine if relative value unit (RVU) volume increases on a per beneficiary basis has counteracted conversion factor decreases and inflation to maintain Medicare reimbursement per beneficiary, overall and across specialties. Full Article

Eric W. Christensen, PhD, Gregory N. Nicola, MD, Elizabeth Y. Rula, PhD, Lauren P. Nicola, MD, Joshua A. Hirsch, MD. 2024. "Medicare Volume Growth and Shift in Payments From Physicians to Non-Physician Practitioners Under Statutory Budget Neutrality," INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Radiologists’ 2021 Quality Reporting and Performance in Medicare’s Merit-Based Incentive Payment System: Analysis by Practice Type

The study shows that radiologists in radiology-only practices score significantly lower in the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) in 2021. The researchers found that radiologists in multispecialty practices score higher, but rarely report any radiology-relevant MIPS quality measures, and instead report measures relevant to other specialties. The findings were published in the American Journal of Roentgenology. Full Article

YoonKyung Chung, PhD, Lauren P. Nicola, MD, Chi-Mei Liu, PhD, and Elizabeth Y. Rula, PhD. 2024. "Radiologists’ 2021 Quality Reporting and Performance in Medicare’s Merit-Based Incentive Payment System: Analysis by Practice Type," American Journal of Roentgenology

Decomposition of Medical Imaging Spending Growth Between 2010 and 2021 in the U.S. Employer-Insured Population (Michal Horny)

Medical imaging, identified as a potential driver of unsustainable US health care spending growth, was subject to policies to reduce prices and use in low-value settings. Meanwhile, the Affordable Care Act increased access to preventive services—many involving imaging—for employer-sponsored insurance (ESI) beneficiaries. The researchers used a large insurance claims database to examine imaging spending trends in the ESI population between 2010 and 2021—a period of considerable policy and benefits changes. Full Article

Michal Horný, Daniel Chang, Eric W Christensen, Elizabeth Y Rula, Richard Duszak, Jr. 2024. "Decomposition of Medical Imaging Spending Growth Between 2010 and 2021 in the U.S. Employer-Insured Population (Michal Horny)," Health Affairs Scholar

Disparities in Provider Ordering Practices of Image-Guided Interventions and Surgery for Patients With Low Back Pain: A Cohort Study

This JACR study assessed individual- and neighborhood-level sociodemographic factors associating with providers’ ordering of nonpharmacologic treatments for patients with low back pain (LBP), specifically physical therapy, image-guided interventions, and lumbar surgery. Full Article

Miriam E. Peckham, MD, Lubdha M. Shah, MD, MS, Huong D. Meeks, PhD, MStat, MPH, Alison Fraser, MSPH, Carlos Galvao, BS, Ghazaleh Safazadeh, MPH, CPH, Troy A. Hutchins, MD, Yoshimi Anzai, MD, MPH, Julie M. Fritz, PhD, PT, ATC, Jacob Kean, PhD, Ruth C. Carlos, MD, MS. 2024. "Disparities in Provider Ordering Practices of Image-Guided Interventions and Surgery for Patients With Low Back Pain: A Cohort Study," Journal of American College of Radiology (JACR)

January 31, 2024

Evidence that Paves The Way for a Brighter Future in Radiology

The Harvey L. Neiman Health Policy Institute is a differentiating asset of the ACR, positioning the College at the forefront in advocacy by contributing the scientific evidence needed to inform health policy. The investment the ACR makes in advancing this mission keeps the College at the forefront of the field and an invaluable partner to Read More

January 24, 2024

The Neiman Imaging Comorbidity Index: Development and Validation in a National Commercial Claims Database

The Neiman Imaging Comorbidity Index (NICI) is an easily calculated measure of comorbidity burden that can be used to adjust for patients’ chances of receiving advanced imaging. Read the JACR study for full details.

January 19, 2024

Radiologists’ Out-of-Network Billing Trends, 2007 to 2021

Given the financial hardships of surprise billing for patients, the aim of this study was to assess the degree to which radiologists effectively participate in commercial insurance networks by examining the trend in the share of radiologists’ imaging claims that are out of network (OON). Radiologists’ imaging claims that are OON has significantly declined from View Infographic

Financial Viability of the No Surprises Act Independent Dispute Resolution Process: Radiology and Other Hospital-Based Specialties

The federal No Surprises Act (NSA), designed to eliminate surprise medical billing for out-of-network (OON) care for circumstances beyond patients' control, established the independent dispute resolution (IDR) process to settle clinician-payer payment disputes for OON care. The objective of this study is to assess the fraction of OON claims for which radiologists and other hospital-based specialists can expect to at least break even when challenging payer-determined payments through the NSA IDR process, as a measure of the process's financial viability. Full Article

Eric W. Christensen, PhD, Mikki D. Waid, PhD, Joshua A. Hirsch, MD, Jay R. Parikh, MD, Ali S. Raja, MD, DBA, James P. Rathmell, MD, MBA, and Elizabeth Y. Rula, PhD. 2024. "Financial Viability of the No Surprises Act Independent Dispute Resolution Process: Radiology and Other Hospital-Based Specialties," American Journal of Roentgenology

October 1, 2023

CT Colonography: A Policy Impasse, or Opportunity?

The ACP now says CTC shouldn’t be used for primary colon cancer screening. USPSTF recommends CTC. Commercial carriers pay for it, but Medicare doesn’t. Why the conflicting policies, and what can the Neiman Health Policy Institute do to help? Read the full ACR Bulletin October 2023 Column