Navigating by Our North Star

By Scott C. Goodwin, MD, FSIR
SIR President
Winter 2014

We are transitioning from an era of fee for service to a new physician payment model at least in part based on reimbursement directly linked to quality. We will likely see cuts in reimbursement for many key interventional radiology procedures. So what are we to do? What will our guiding star be, our North Star, if you will? Foremostly, we must keep our eyes and actions directed on what we do best: ensuring constant access to and delivery of longitudinal high-quality, image-guided patient care. As part and parcel of this we must remain actively engaged in influencing the outcome of the evolving payment paradigms.

How will 2014 payment cuts impact care delivery and patient access? Reimbursement issues affect both doctors and our patients by impacting what services we offer and the time we spend with patients. These can negatively impinge on patients’ access to quality doctors (thus adding to their stress and diminishing their satisfaction levels).

How can we as a Society best influence reimbursement decisions? In this nationally mandated process of squeezing savings from the health care system, interventional radiology is not alone. We share and collaborate with colleagues from other specialties when payment rates are being reduced (due to code bundling and cumulative reductions). SIR remains an active participant in the national current procedural terminology (CPT) coding process and the accompanying code-valuation, which take place as part of the activities of the Relative Value Scale Update Committee (RUC).

What payments cuts are coming? In 2014, new families of CPT codes for embolization procedures, intravascular stenting and percutaneous drainage have been approved and are now in use. Depending on geographic variations we expect reimbursement for some of these procedures to possibly fall by as much as 30–40 percent.
SIR has invested hundreds of volunteer hours and member resources in ensuring that our coding and valuation strategy is grounded on sound data and on what is the optimal patient care protocol. We have worked long and hard, and we were able to preserve excellent value for IR treatments. In a comment letter to Centers for Medicare & Medicaid Services (CMS) on the 2014 Final Rule for the Medicare Physician Fee Schedule, we have emphasized that the best venue for making relative value unit (RVU) decisions is to use the RUC process, and not to make unilateral further reductions beyond what the RUC recommended without input from specialty societies. We will continue to engage federal authorities and remain active on Capitol Hill to ensure that the payment system is fair and appropriate, and, most importantly, that IR’s voice is heard.

Are we at a financial tipping point for the specialty of interventional radiology? Interventional radiologists deliver high-quality care in a financially sustainable environment, so there’s no doubt that we will thrive in the evolving health care system. The end products that IR delivers with image-guided interventions (less risk, less pain, less recovery time, less expensive, same-day treatments, fewer readmissions) remain critical attributes for new health care delivery models. We support patient-centered outcomes research, which will educate patients and help them make better medical decisions.

Creating and meeting this demand for medical care quality is a golden opportunity for IR during the transition from fee for service to reimbursement directly linked to quality. IR is a distinct and valuable medical specialty. We are seeking to differentiate IR from other specialties, proving how it is a true game changer in the health care system.

You will hear more about how we are in the process of clearly redefining who we are in this new health care setting, strategically following our North Star—ensuring constant access to and delivery of longitudinal high-quality, image-guided patient care.

We need more than a few good men and women to actively assist our coding/health policy efforts. Please consider volunteering your time and talents (703-691-1805).