The Economic Impact of AI on Breast Imaging.

This article explores the development of computer-aided detection (CAD) and artificial or augmented intelligence (AI) for breast radiology examinations and describes the current applications of AI in breast imaging. Although radiologists in other subspecialties may be less familiar with the use of these technologies in their practices, CAD has been used in breast imaging for more than two decades, as mammography CAD programs have been commercially available in the United States since the late 1990s. Likewise, breast radiologists have seen payment for CAD in mammography and breast MRI evolve over time.

An Overview of the Radiation Oncology Alternative Payment Model and Impact on Practices Serving Vulnerable Populations.

Radiation oncology reimbursement methodology has been largely unchanged over the past 30 years, and new approaches are of great interest to practicing radiation oncologists and other health care stakeholders. Traditional radiation oncology reimbursement is based on a series of individual codes for evaluation and management (professional) and technical services, yielding a complex reimbursement system. In an attempt to move toward a simpler, episodic payment model, bundling all of the codes into a single payment, an alternative payment model for radiation oncology was developed.

Who Will Pay for AI?

In 2020, the largest U.S. health care payer, the Centers for Medicare & Medicaid Services (CMS), established payment for artificial intelligence (AI) through two different systems in the Medicare Physician Fee Schedule (MPFS) and the Inpatient Prospective Payment System (IPPS).

Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations.

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

Methods: Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time.

Results: Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.

Breast Imaging Radiologists' Role in Value Pathways.

The Merit-Based Incentive Payment System (MIPS) has fallen short of its intended goal to substantially transform the delivery of healthcare by tying clinician payments to quality and cost reduction. Policy makers made changes to the program over its first five years in efforts to address concerns about complexity and lack of meaningful impact on outcomes for our patients. One of these changes, the creation of MIPS Value Pathways (MVPs), aims to streamline reporting of increasingly aligned measures and serve as a stepping-stone for the transition to alternative payment models.

Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound.

Current descriptions of ultrasound evaluations, including use of the term "point-of-care ultrasound" (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness.

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work.

Purpose: The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines.

Methods: Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region.

Clinical Decision Support: The Law, the Future, and the Role for Radiologists.

Clinical Decision Support (CDS) was designed as an interactive, electronic tool for use by clinicians that communicates Appropriate Use Criteria (AUC) information to the user and assists them in making the most appropriate treatment decision for a patient's specific clinical condition. Policymakers recognized AUC as a potential solution to control inappropriate utilization of imaging and made CDS mandatory in the Protecting Access to Medicare Act of 2014. In the years since Protecting Access to Medicare Act, data on the potential impact of CDS has been mixed and much of the physician community has expressed concern about the logistics of the program.

The Quality Measure Crunch: How CMS Topped Out Scoring and Removal Policies Disproportionately Disadvantage Radiologists.

Purpose: CMS implemented Merit-Based Incentive Payment System (MIPS) policies to cap points and remove "topped out" quality measures having extremely high national performance. We assess such policies' impact on quality measure reporting, focusing on diagnostic radiology.

Methods: Data regarding MIPS 2019 quality measures were extracted from the CMS Quality Benchmarks File and the Quality Payment Program Explore Measures search tool and summarized by collection type and specialty.

The Alternative Payment Model Pathway to Radiologists' Success in the Merit-Based Incentive Payment System.

Purpose: To assess 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.

Methods: Data regarding radiologists' 2017 MIPS performance was extracted from the Physician Compare 2017 Individual EC Public Reporting-overall MIPS Performance data set, and additional physician characteristics were extracted from multiple CMS data sets.

Results: Among 20,956 MIPS-participating radiologists, 16.

A Business Case for Artificial Intelligence Tools: The Currency of Improved Quality and Reduced Cost.

For data science tools to mature and become integrated into routine clinical practice, they must add value to patient care by improving quality without increasing cost, by reducing cost without changing quality, or by both reducing cost and improving quality. Artificial intelligence (AI) algorithms have potential to augment data-driven quality improvement for radiologists. If AI tools are adopted with population health goals in mind, the structure of value-based payment models will serve as a framework for reimbursement of AI that does not exist in the fee-for-service system.

Facility-Based Measurement in the Merit-Based Incentive Payment System: A Potential Safety Net for Which Most Radiologists Will Be Eligible.

The purpose of this study was to assess the percentage and characteristics of radiologists who meet criteria for facility-based measurement in the Merit-Based Incentive Payment System (MIPS). The Provider Utilization and Payment Data: Physician and Other Supplier Public Use File was used to identify radiologists who bill 75% or more of their Medicare Part B claims in the facility setting. Among 31,217 included radiologists nationwide, 71.

Medicare Access and Children's Health Insurance Program Reauthorization Act: The Basics for the Breast Imaging Radiologist.

Breast imaging radiologists are considered by many to be leaders among diagnostic radiologists in the transition to value-based care. Many strategies for success in the changing healthcare landscape are exemplified by the day-to-day practice of breast imaging, including well-developed quality measures, standardized accepted best practices and terminology, and a prominent role in communicating with patients and coordinating care. Further development of these strategies will be important for continued success in both the Merit-Based Incentive Payment System and in alternative payment models.

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

Purpose: 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.

MACRA 2.5: the legislation moves forward.

The Medicare and CHIP Reauthorization Act of 2015 remains the payment policy law of the land. 2017 was the first year in which performance reporting will tangibly impact future physician payments. The Centers for Medicare & Medicaid Services (CMS) considers 2017 and 2018 transitional years before full implementation in 2019.

Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

Background: Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources.

Objective: Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury.