October 30, 2019
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
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)
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
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.
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
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.
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.
This paper specifically studies the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) and determines how this incentive program affects computed tomography (CT) use, and how it could be redesigned to minimize unnecessary CT scans. Full Article
Zhang, H., Wernz, C., Hughes, D.R. 2016. "Modeling and Designing Health Care Payment Innovations for Medical Imaging," Health Care Management Science
This study reports that breast cancer screening provides a framework for radiologist-led bundled payment models. Full Article
Hughes, D.R., Jiang, M., McGinty, G.B., Shetty, S., Duszak Jr, R. 2017. "An Empirical Framework for Breast Screening Bundled Payments," Journal of the American College of Radiology, 14(1): 17 - 23.