Radiology’s ACO Play: Get in the Game—Now

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

The ACO, a relatively new concept that met with great skepticism when it appeared in the Patient Protection and Affordable Care Act, now ranks at the top of the conversation-starter list in the radiology community. Imaging providers have debated whether it is necessary for them to engage with these entities, and, if they do, what roles they would play. The current consensus not only is that radiology cannot afford to ignore the ACO model, but also that a strategic approach must be followed if providers are to assume their positions successfully under the ACO umbrella. Some (if not many) radiologists have made no immediate attempt to procure a seat at the ACO table, instead adopting a wait-and-see attitude or ignoring the issue entirely. Such procrastination is shortsighted at best, according to W. Kenneth Davis Jr, JD, partner with Katten Muchin Rosenman LLP. He says that providers who envision themselves joining Medicare ACOs must bear in mind that unless they take action now, they might find themselves with little decision-making power later. His rationale: Medicare ACOs are required to sign a three-year contract with Medicare; during this initial period, they can terminate participants, but cannot bring aboard any additional ones, be they operators, founders, or owners. It’s just as significant that while ACOs in this category can add providers and suppliers on a contract basis (within the first 36 months in which an agreement is in force), contract players cannot be assigned governance roles within the organization. “This, in itself, should be impetus to move today—not tomorrow,” he says. Despite the widely acknowledged fact that ACOs—Medicare and otherwise—are in the formative stages of development and have not hit their stride, radiologists’ chance to forge appropriate ACO alliances with the highest potential for long-term success is greater today than it will be in the not-too-distant future. Bibb Allen Jr, MD, FACR, serves as a diagnostic radiologist in the Birmingham Radiological Group in Alabama and as vice chair of the ACR ® Commission on Economics. He is also the lead author of an ACR white paper¹ on the subject. In the white paper, Allen et al point out that ACOs might cultivate partnerships with multiple radiology groups, entertain proposals from radiology groups based at different hospitals, and/or consider using the services of outside teleradiology companies to satisfy their imaging-services needs. As a guarantee of future ACO affiliation, “complacency and reliance on existing provider contracts at participating hospitals are not options,” Allen says. The longer the delay in attempting to sit down at that ACO table, he adds, the smaller the number of remaining tables from which to choose. Making the Transition For radiology, gaining entry into the ACO arena and becoming a key player in the delivery of care through an ACO model are heavily predicated on a willingness and ability to offer significant added value in the management of population health. Assuming a utilization-management role that involves the assessment of imaging appropriateness and advocacy for the safest, most accurate diagnostic tests—no matter the payment methodology—is key. Chip Hardesty serves as COO of Radiology Ltd (Tucson, Arizona), which—in addition to outpatient services—provides imaging for Tucson Medical Center. The facility, along with two other independent physician groups, was one of five Brookings–Dartmouth ACO pilot sites. Hardesty notes, “ACOs are all about sharing and reducing costs without compromising the quality of care. Radiologists—who know better than other physicians which tests are best suited to which cases and when it is prudent to opt for (or against) a certain test—are in a perfect position to go beyond interpretations and act as utilization-management resources. What’s more, while it may be fairly easy for ACOs to outsource image interpretation, utilization management is much tougher to outsource, making it a very valuable way to add value.” In assessing imaging appropriateness, overseeing utilization, and administering imaging programs, Hardesty says, it behooves radiologists to use such IT tools as computerized provider order entry (CPOE) with decision support. In weighing in on imaging appropriateness and executing other tasks related to utilization management, however, radiologists must present feedback that is not limited to findings derived from CPOE with decision support and similar technologies,