August 25, 2006

Summary of the ACR Intersociety Meeting:
“Quality – A Radiology Imperative”
Nancy Ellerbroek, MD, FACR
AAWR President

The recent Intersociety Conference “Quality – A Radiology Imperative” was an inter-disciplinary radiology meeting with participation from imaging and interventional radiologists, radiation oncologists, and radiation physicists. The focus was on quality and safety in radiology as it related to Pay for Performance (P4P) The purpose of this meeting included reviewing the issue and recommending metrics that can be used for P4P. The goal was to develop metrics that were simple, measurable; outcome oriented, and expected to improve patient care.

I was impressed by was how sincere the organizers and participants were to accomplish the goals in a collaborative way, with active participation encouraged by all attendees. I was very interested in the process and outcomes, not just as the AAWR representative, but personally, as P4P is expected to affect me directly as a private practitioner. Because this is a new program, I have prepared some background information, paraphrased and summarized from the ACR website:

Definition of Pay-for-Performance (P4P): "The use of incentives to encourage and reinforce the delivery of evidence-based practices and health system transformation that promote better outcomes as efficiently as possible,"

History of Support for program:

• Initially main impetus from private and public payers and large employers
• Momentum from advocacy groups such as Institute of Medicine

Current Status:

• Standard methodology of quality Assessment –structure-process-outcome model
• In December 2005, the American Medical Association (AMA) sealed an agreement under which Congress would delay implementation of Medicare cuts if the AMA would produce 140 performance measures for all major specialties by January 1, 2007.
• These measures are a method of determining the quality of services provided by collecting data from providers and giving incremental rewards for those providers that meet or exceed benchmarks.
• Beginning in 2007, physicians will be required to participate and the data from 2007 will be part of the basis for benchmarks for rewards to begin in 2008.
• The ACR is now working with the AMA to develop performance measures specific to radiology, for example, The ACR is serving with the American Academy of Neurology as co-lead organizations in the development of Stroke and Stroke Rehabilitation measures that will include specific measures that relate to imaging for this condition.
• Currently there are over 110 pay-for-performance programs in the United States (used by private and some public payers).
• Some additional programs involve relationships between hospitals and payers, but very few programs include hospitals and physicians.
• The Physician Voluntary Reporting Program (PVRP) was initiated by CMS on January 1, 2006, to capture data about the quality of care provided to Medicare beneficiaries through reporting G-codes. The reporting is based on a core starter set of 16 performance measures from a larger set of 36. These initial measures are focused on primary care and may be viewed at http://www.cms.hhs.gov/PVRP/.
• Physicians participating in this voluntary program began to receive data feedback in the spring of 2006. There are no radiology measures in this initial starter set or in the larger set of 36. However, CMS is currently soliciting performance measures for radiology, and this program will likely serve as the model for future reporting scheduled to begin in 2007 that will include imaging

The Program Chair was N. Reed Dunnick, MD. Kimberly Applegate was on the executive Committee that organized the meeting as well as one of the speakers. Her talk: Quality Strategy- Pay to Play or P4P? focused on the differing strategies used to measure quality. She noted that the goal of P4P is to create a compelling set of incentives to drive breakthroughs improvements in clinical quality and patient experience. She noted that while deciding what we want to improve and developing metrics, we need to be mindful of which metrics are important, not just what we can measure easily.
Other talks covered appropriateness and access, report timeliness, patient safety issues, interpretation accuracy and pertinence. The role of information technology was discussed, and examples of successful use of IT were given. Quality for interventional radiology and radiation oncology was discussed. The new RSNA Radlex project was previewed by Curtis Langlotz, MD, PhD, and Dr. Borgstede talked about the new National Data Registry. Details about all of these initiatives will likely be posted on the ACR website, which currently has a special section devoted to Pay for Performance.
After the workgroups met for a second time, the metrics were developed. The final list included:

• 8 metrics dealing with access and appropriateness
• 26 metrics related to patient safety
• 12 metrics related to the radiology report
• 3 metrics related to patient satisfaction surveys
  It is hoped that all of the effort that goes into participation in Pay for Performance Programs can be applied in such a way that credit will be given towards meeting accreditation and Maintenance of Certification requirements.

Citations

1. Birkmeyer NJO, Birkmeyer JD. Strategies for Improving Surgical Quality-Should Payers Reward Excellence Or Effort? N Engl J Med 353: 864-871, 2006

2. Milgate K, Bee Cheng S. Pay-for-Performance: the MedPAC Perspective Health Affairs 25: 413-419, 2006

3. Hillman BJ. Who gets paid with "pay-for-performance"? J Am Coll Radiol 2004;891-2.
http://www.jacr.org/article/PIIS1546144004003795/fulltext

4. Seidel RL, Nash DB. Paying for performance in diagnostic imaging: current challenges and future prospects. J Am Coll Radiol 2004;952-6.
http://www.jacr.org/article/PIIS1546144004002923/fulltext