The final ruling on the Medicare Access and CHIP Reauthorization Act (MACRA) was released in early October and, while there were some positive surprises for radiologists, hospitals and imaging centers need to work to ensure compliance in billing and reporting. Lack of knowledge about the looming changes, an uneven playing field with payors and the shift from volume to value could all undercut profitability at an imaging practice.

1. Educate clinicians and support staff about best practices

A sobering 50 percent of all U.S. physicians are unfamiliar with MACRA, according to a Deloitte survey. This could seriously hurt their reimbursements under new models, which are based on reporting from September 2015 to August 2016.

“Whether they know it or not, their performance going forward is going to be based on 2016 data,” said Anthony Gabriel, COO of Radiology Partners, a nationwide radiology practice based in El Segundo, California. “Some of these guys are going to end up on the lower end of the reimbursement curve.”

To avoid any of their physicians slipping into the lower tiers of reimbursement, Radiology Partners has ensured they are informed through short webinars and modifications to workflows. Radiologists receive feedback on their data reporting, letting them know if they are delivering the additional data on MACRA measures that can propel practices to higher percentile reimbursements. The integration with their usual workflow is the most beneficial aspect, according to Gabriel.

“We didn’t have to create something new,” he said. "It was simply an extension of a process we were already doing."

2. Strive for more effective negotiation with payors

The healthcare industry has seen a rash of consolidation over the past few years, driven by struggles with profitability and an increasingly segmented market. In addition, consumers are pickier, expecting to see their healthcare dollar go further as they pay for a larger share of their care.

Proposed mergers such as Aetna/Humana and Anthem/Cigna increase the measure of market concentration, reducing the ability of imaging practices to negotiate. In addition, large payors such as these have full teams of contract negotiators, putting smaller radiology practices on their heels.

“These are experts who do nothing but negotiate contracts,” said Gabriel. “It’s important to bring expertise in-house that can dedicate themselves to negotiating these contracts, but it can be difficult for small practices.”

3. Demonstrate clinical value

MACRA is demanding a shift from volume to value, and it’s the radiology department’s responsibility to stake a place for itself in this new healthcare dynamic. Practices like Radiology Partners contract with the hospital, but the practice receives most of its payments from larger payors. However, increasing use of outcome measures means the hospital is more responsible for patients—and they’ll be looking for more from their radiology group.

“They’ll be asking, 'What value are you bringing?’ and if you can’t deliver that data, you’ll be in a rough spot compared to other specialties,” said Gabriel.

While these changes aren’t all going to happen within the next year, radiology departments need to start thinking about how to respond, according to Gabriel.

“There are several questions radiology departments need to ask themselves,” he said. “Do you have the infrastructure? Can you afford negotiation expertise? Do you have the data and technology to deliver the data to participate in the reimbursements that are coming down the pike?”