Researchers have interrogated the DRG database to come up with initial targets for help with negotiating bundled payments.
Data is fairly easy to aggregate in large amounts. The problem, according to David A. Rosman, MD, MBA, is making sense of it all. Rosman, a radiologist at Massachusetts General Hospital, made that point at a session he moderated on “The Future of Radiology Payments: Can Analytics Help Radiologists Regain Control,” on December 1, 2014, at the annual meeting of the Radiological Society of North America in Chicago.
Using the Ebola outbreak as an example, Rosman pointed out that cell phone usage in Africa has exploded over the last several years. (Rosman currently is in Rwanda, where he is creating a radiology residency program under a larger grant to build a medical infrastructure in that country.)
“People who can’t afford a meal a day are walking around with cell phones,” he said. “It’s quite stunning.” A huge amount of potentially useful data can be found on these phones if the texts, tweets and Facebook posts communicated through those phones are aggregated.
“All of that data is useless unless you ask the right question,” Rosman says. “But, what if you ask the right question—like how many of these mention the word ‘fever’ and ‘blood’ or ‘Ebola.’ You could focus care, you could know where the disease is creeping up and getting worse, because we can identify exactly what is happening with these cell phone records.”
How can a data analytics approach help radiology as a specialty, particularly as it begins to look at new payment and delivery systems? That’s one of the issues the Harvey L. Neiman Health Policy Institute (HPI) has been evaluating since it was established by the American College of Radiology in 2012.
Can analytics lead the way?
To put that question into context, presenter Richard Duszak, MD, HPI chief medical officer and senior research fellow, refers to a report from the National Commission on Physician Payment Reform (released in March 2013) that begins with this quote: “Our nation cannot control runaway spending without fundamentally changing how physicians are paid.”
“If you believe that our healthcare system is broken and that our payment systems are contributing to that, then you’ll probably agree with that,” Duszak says. “But, if you are a practicing physician, you’ll ask, ‘What does this mean for me?’”
Abdicating how radiologists get paid to people who may or may not know what radiologists do in clinical practice is a frightening proposition, he adds. “It’s important for all of us as practice leaders and practice radiologists to give this a lot of thought and come up with some meaningful approaches to what would happen to [radiologists if they are] pushed into some kind of bundled payment system,” he warns.
While physicians can expect the payment system to evolve from a fee-for-service to a fee-for-value world, how exactly they will get there is unclear. It could involve pay for performance, episodic bundled payments or population health management with large patient populations captured by health systems for long periods of time.
The focus of Duszak’s talk was on episodic bundled payments, which he acknowledges is one of the easier ones to model because there has been some precedents: Under Medicare, hospitals have historically received single bundled payments under the Inpatient Prospective Payment System based on Diagnosis Related Groups (DRGs).
One of the problems with the system, Duszak says, is that it “has created some perverse incentives.” For example, he explains, if a hospital gets paid $10,000 for a particular admission that should require a five-night hospital stay, the hospital can bring in more money by releasing the patient in four days and flipping the bed to a new patient a day early.
On the other hand, physicians are generally paid on a fee-for-service arrangement based on actual services rendered as reported, using Current Procedural Terminology (CPT) codes. As Duszak points out, critics have suggested that this leads physicians to administer more tests and perform more studies.
“While the hospital may have incentives to get that patient out,” Duszak says, “in a true dollar sense, the more we image patients, the more we get paid. So, we have created these misaligned incentives in our systems.”
Making sense of big data
When attempting to divide a bundled payment among physicians, things get complicated fast, Duszak says. “That’s why a lot of these discussions