Measuring and tracking virtually all aspects of operations has become increasingly important for radiology groups today, not just to improve financial performance but also to meet an expanding number of compliance requirements and reimbursement changes.
Practices are diving deep into the data to support decisions ranging from staffing and modality mix to practice expansion. At the same time, quality and performance reporting is becoming increasingly imperative as more reimbursement is tied to a practice’s ability to demonstrate value and accept risk in multiple areas.
“What we’re seeing is that groups are going beyond traditional revenue cycle metrics and harnessing disparate systems data like RIS/PACs and EMRs,” said Pat Free, national vice president of radiology operations for McKesson Business Performance Services (McKesson). “Groups are working with their healthcare partners to use this information to identify ways to value, monitor and track both patient and practice success.”
Free said key performance indicators continue to be an essential foundation for monitoring a practice’s financial performance. Tracking relative value units, for example, can help leaders understand both individual physician productivity as well as overall group performance.
Groups also are using data-driven analytics to examine reference patterns, patient-to-procedure ratios, and to determine if area demographics will support new services, such as gender-specific imaging or interventional radiology. At the same time, groups are tracking quality and patient success, both to meet the requirement of programs like the Physician Quality Reporting System (PQRS) and to demonstrate value to partners and patients.
“Things like turnaround time, accuracy results and productivity are increasingly important for partners, payers and patients,” Free said. “More and more payers are developing pay-for-performance mechanisms to improve quality and value.”
He noted that quality reporting is central to the Centers for Medicare & Medicaid Services’ (CMS) new bundled care payments demonstration, which includes 864 hospital and medical group participants.1 Projected costs for traditional inpatient, post discharge acute care and related services that begin within 30 days of the inpatient stay and will end either 30, 60, or 90 days after the initiation of the episode are being bundled for up to 48 separate clinical episodes of care under Model 2 - Retrospective Acute Care Hospital Stay plus Post-Acute Care and Model 3 - Retrospective Post-Acute Care Only.2 Providers will be paid traditional fee-for-service payment during the care period, but CMS will subsequently reconcile actual payments against targeted costs to provide bonuses or recoup over-payments, depending on outcomes.3
New measures coming
Recent legislation expanding value-based purchasing by Medicare also is likely to create new metrics for physicians to track, Free noted. The Medicare Access and CHIP Reauthorization Act (MACRA), passed in April 2015, did away with the flawed Sustainable Growth Rate formula (SGA) for establishing provider reimbursement levels and instead created a merit-based incentive program known as MIPS. This carrot/stick approach is designed to shift patients into risk based reimbursement programs as well as penalize high-cost, low-quality providers.4
MIPS will combine a number of existing Medicare value-based initiatives into a single program and create a simplified composite scoring system to assess provider performance across the four key areas: Quality, Resource Utilization, Practice Improvement and Technology Adoption and Utilization. MACRA’s second track, Alternative Payment Models (APMs), will offer new financial incentives and broad collaborative opportunities for new participants in value-based purchasing initiatives.
Free noted that CMS has opened a request-for-information process to help understand how best to roll out the program. He said that it’s important that groups monitor program development next year based on the feedback CMS receives during the RFI period.
“This process will define not only what providers will need to do to fully participate in any incentives offered but, equally important, how they can avoid financial penalties,” Free said, adding that the program is expected to impact reimbursements potentially starting in 2019 and beyond.