Advisory Board Company’s Imaging Performance Partnership research offers insights for imaging leaders.
Recent years have seen transformational change occur in the American health care market. Keeping up with each development is daunting, but equally challenging is identifying the implications of these changes on the future of health care delivery and payment. Below are three major takeaways for imaging leaders, courtesy of the Advisory
Board Company’s Imaging Performance Partnership research team. This outlook can serve as a guide for forging a successful radiology strategy in 2016 and beyond.
- Explore screening and interventional radiology programs as growth opportunities
Recent years have seen low-dose CT (LDCT) lung cancer screening and CT colonography (CTC) receive approval from the United States Preventive Services Taskforce (USPSTF) as essential health benefits. These decisions open the door for radiology providers to provide these potentially life-saving services to patients in an affordable way, while also demonstrating radiology’s value proposition as a gateway to the health system. Many providers also are exploring mobile mammography and partnerships with employers as a way of growing their programs. In order to ensure the success of these new initiatives, it is vital to deploy marketing strategies to referring physicians about the benefits and potential harms of these services.
Similarly, interventional radiology (IR) has had new life breathed into the specialty as pioneers advance the list of procedures outside of vascular services. Additionally, IR is attractive to both patients and health systems due to its noninvasive nature, its low cost compared to surgical approaches and the great outcomes results. Institutions with existing IR programs should align their growth with non-procedural specialties like oncology, pediatrics and primary care. Several programs have also seen success marketing IR directly to patients who are seeking an alternative to invasive surgeries.
- Prepare for continued bundling and streamlining of outpatient Medicare reimbursement
CMS has made headlines recently with its decision to mandate bundles for joint replacement and cardiology services. In contrast to many alternative payment models, these programs are mandatory for virtually all providers in the selected markets. Since imaging plays a vital role in the care pathways for these new bundles, imaging leaders need to involve themselves in developing standardized processes and identifying utilization trends. But the impact of CMS’s changes to outpatient reimbursement does not stop there.
There were 54 imaging APCs in 2015. CMS’s most recent proposed reimbursement rule would reduce that number to 8. This is the second year in a row that CMS has suggested significant streamlining of imaging APCs. The agency has cited its desire to pay for episodes of care, rather than specific services, as the motivation for this change. Previous streamlining has led to reductions in reimbursement, but the lingering question is whether the streamlining will lead to further inclusion of imaging services in outpatient bundles.
- Identify opportunities to participate in population health management
At its core, population health management is taking a limited set of resources and strategically deploying them to optimize the health of groups and individuals over time. Despite the popularity of this approach to health care delivery, many imaging providers have not been invited to participate in health system discussions on the topic. It is vital for imaging leaders to be proactive and engage in conversations with health system leaders around how imaging can support their efforts, or risk being left out of the discussion.
Radiology providers can insert themselves into the conversation by focusing their efforts on initiatives that improve quality and lower total cost of care. Examples of these types of initiatives include imaging screening programs, utilization management and incidental findings management. These programs not only meet the goals of improved quality and reduced cost, but they reduce the likelihood of patient risk escalation and can keep patients loyal to the health system. #radiology #AimtoInnovate
To learn more about this and other topics in the market, visit the Imaging Performance Partnership’s blog The Reading Room, and follow them on twitter (@Advisory_IPP).
Solomon Banjo has been a researcher at the Advisory Board Company since 2013.
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