Alternative Health Care Models

Neurointerventional payment for out-of-network mechanical thrombectomy in the era of the No Surprises Act

Congress enacted the No Surprises Act (NSA) in 2021. The NSA relies on the ability for providers to appeal their out-of-network payment through an arbitration process known as Independent Dispute Resolution. This study was designed to evaluate the effective access to IDR for mechanical thrombectomy. Full Article

Jonathan A Grossberg, Eric W Christensen, James M Milburn, Guilherme Dabus, Richard E Heller III, Joshua A Hirsch. 2024. "Neurointerventional payment for out-of-network mechanical thrombectomy in the era of the No Surprises Act," Journal of NeuroInterventional Surgery

Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations

The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). Full Article

Stefan Santavicca, MS, Richard Duszak Jr, MD, Nicola Gregory, MD, Lauren Golding, MD, Andrew Rosenkrantz, MD, Christian Wernz, MD, Danny Hughes, PhD. 2021. "Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations," Journal of American College of Radiology (JACR)

October 30, 2019

How do Radiologists Perform in MIPS using the “MIPS APM” Pathway?

This study assessed radiologists’ performance in the Merit-Based Incentive Payment System (MIPS), with attention to the impact of the novel MIPS-Alternative Payment Models (APMs) participation option created under the Medicare Access and CHIP Reauthorization Act. View Infographic

Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models

Bundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening. Methods: Using 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT. Full Article

Margaret M. Fleming, MD, MS, Danny R. Hughes, PhD, Lauren P. Golding, MD, Geraldine B. McGinty, MD, MBA, Dan MacFarlane, BS, CPA, Richard Duszak Jr, MD. 2019. "Digital Breast Tomosynthesis Implementation: Considerations for Emerging Breast Cancer Screening Bundled Payment Models," Journal of American College of Radiology (JACR), 16(7)

Private Practice Radiologist Subspecialty Classification Using Medicare Claims

The purpose of this study was to assess both existing Medicare provider code assignments and a new claims-based system for subspecialty classifying private practice radiologists. Full Article

Rosenkrantz, A.B., Wang, W., Bodapati, S., Hughes, D.R., Duszak, R. 2017. "Private Practice Radiologist Subspecialty Classification Using Medicare Claims," Journal of the American College of Radiology

Academic Radiologist Subspecialty Identification Using a Novel Claims-Based Classification System

This study assesses the feasibility of a novel claims-based classification system for payer identification of academic radiologist subspecialties. Full Article

Rosenkrantz, A.B., Hughes, D.R., Wang, W., Ginocchio, L., Rosman, D.A., and Duszak, R. 2017. "Academic Radiologist Subspecialty Identification Using a Novel Claims-Based Classification System," American Journal of Roentgenology, 208(6): 1249 - 1255.

MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology

This paper suggests that patient-focused physician models provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, and may foster greater radiologist participation in APMs under MACRA. Full Article

Rosenkrantz, A.B., Nicola G.N., Allen, B., Hughes, D.R., and Hirsch, J.A. 2017. "MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology," Journal of the American College of Radiology

The Proposed MACRA/MIPS Threshold for Patient-Facing Encounters: What It Means for Radiologists

This report found that CMS’ proposed criteria for special considerations in new payment models would result in many radiologists being evaluated using measures not reflective of their practice. Full Article

Rosenkrantz A.B., Hirsch J.A., Allen B. Jr., Wang W., Hughes D.R., Nicola G. 2017. "The Proposed MACRA/MIPS Threshold for Patient-Facing Encounters: What It Means for Radiologists," Journal of the American College of Radiology, 14(3): 308 - 315.

MACRA, MIPS, and the New Medicare Quality Payment Program: An Update for Radiologists

This report provides an overview of CMS’ proposal for implementing MACRA legislation via the new QPP, paying specific attention to the implications and imperatives for radiologists under MIPS. Full Article

Rosenkrantz, A.B., Nicola G.N., Allen, B., Hughes, D.R., and Hirsch, J.A. 2017. "MACRA, MIPS, and the New Medicare Quality Payment Program: An Update for Radiologists," Journal of the American College of Radiology, 14(3): 316 - 323.

September 19, 2016

Radiology and the Shared Savings ACO

A new Neiman Institute paper, published in collaboration with industrial engineers from Virginia Tech, investigates how the incentives in an alternative payment model, the Accountable Care Organization Share Savings Program, might influence cost, quality, utilization, and technological investment. Read More