The College has taken the lead on many important issues over the years — in part through collaborating and building partnerships with other specialty associations and organizations. The Bulletin spoke with ACR CEO William T. Thorwarth Jr., MD, FACR, for a look back at how these strategic partnerships have helped the College reach its goals.
How has the ACR forged invaluable partnerships with other medical societies over the years, and why should this matter to our members?
Throughout the last century, the ACR has collaborated with many radiology and other medical societies to ensure that our common interests and those of the professions and patients are best served. An early example is the formation of the ABR, validating our specialty. This was a joint effort of the ACR, RSNA, the American Roentgen Ray Society and the Radium Society, which was started in 1932 and completed in 1934 with the first group of graduated Diplomates.1
The ACR worked closely with the College of American Pathologists (CAP) and the American Society of Anesthesiologists (ASA) in ensuring that all three specialties were included in Part B of Medicare in 1965 so that those specialists were treated the same as all other physicians.2 These groups came together again to stifle the attempt by the Reagan administration to implement the “RAP” proposal, which called for Medicare to issue payments for radiology, anesthesiology and pathology services (RAPs) to include our Medicare payments in hospital billings — and based on average cost instead of fee for service.3
A collaborative effort with the RSNA that began back in 2000 resulted in the development of RadiologyInfo.org. This patient-focused website contains up-to-date descriptions of more than 260 procedures, exams and diseases covering diagnostic and IR, nuclear medicine, radiation therapy and radiation safety. It has become quite popular, receiving more than 2 million hits a month.
In another collaboration, an advocacy coalition of more than 100 societies, led by the ACR, has successfully mitigated scheduled Medicare reimbursement cuts for 2021, 2022, 2023 and 2024, reclaiming over $1.5 billion for radiologists.
For our members, imagine if the ACR was not here, those collaborations had not occurred and those accomplishments had not been achieved.
What are some of the collaborations you’ve been most proud of over the years?
During my years working with the ACR Commission on Economics, the AMA CPT® Editorial Panel and the AMA/Specialty Society Relative Value Scale Update Committee (RUC), I’m proud of the collaborative work that has been done by our dedicated volunteers and staff. In each of those venues, with both the associated radiology society advisors and those of other specialties, we’ve worked together on constructing accurate coding descriptors for our widely varied and complex procedures and then achieving appropriate reimbursement levels in a very challenging environment.
Secondly, the ACR has achieved growing impact in the two major multispecialty organizations, the AMA and the Council of Medical Specialty Societies (CMSS). At the AMA, we team with other members of the Radiology Section Council, totaling approximately 75 delegates, as well as the Hospital-Based Physician Caucus to advance AMA policies favorable to our specialties and the patients our members serve. At the CMSS, we have extensive senior staff engagement with the professional peer groups so they may learn from their counterparts in other societies and demonstrate the College’s sophisticated programs.
Recently, I am very proud of the ACR acting as the initial convener and now as a member of the independent Radiology Health Equity Coalition (RHEC). The nine organizations that now form the “Mobilization Team” and the “Partners” are doing great work, collaborating with community health-based organizations, including federally qualified health centers, to correct widespread disparities in healthcare access.
An excellent example is the initiation of the first annual Lung Cancer Screening Day co-sponsored by RHEC with the American Cancer Society National Lung Cancer Roundtable, the ACR and the GO2 Foundation that recruited more than 300 radiology practices around the country to open their doors on Nov. 11, 2022. That Saturday was set aside for performing low-dose CT lung screening, allowing those who could not take off work during the week to take advantage of this lifesaving procedure.
Finally, and still a very active collaborative undertaking, is our joint legal activity working to ensure proper implementation of the federal No Surprises Act (NSA) legislation (read the RADLAW column in the April issue of the Bulletin). It was a bold step by the ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists to sue three agencies of the federal government (the Departments of Health and Human Services, Labor, and Treasury) when they attempted to tip the scales in favor of the insurance industry contrary to the legislative language. The College was, and remains, fully in support of protecting patients from “surprise billing,” but the members of each of our organizations, and all physicians, must have a level playing field considering all factors as described in the law when it comes to disputes with payers over proper reimbursement for out-of-network services.
How do partnerships advance high-quality patient care and make the College stand out as a leader?
The ACR Commission on Quality and Safety (Q&S) and all supporting staff do a tremendous job in coordinating with both radiology subspecialty societies and other medical specialties in the development of our Practice Parameters and Technical Standards as well as the ACR Appropriateness Criteria®. The inclusion of these many varied perspectives adds to the legitimacy of those respective documents and makes each of those sets of recommendations more effective in advancing high-quality and appropriate radiological care.
We also collaborate closely with multiple patient advocacy groups through our Commission on Patient- and Family-Centered Care (PFCC). There are multiple patient committee members, including co-chairs, who ensure we include this extremely critical viewpoint and input. As stated by former PFCC Chair James V. Rawson, MD, FACR, “It is hard to put the patient at the center if you are standing there yourself.”
The highly effective work of our Government Relations teams has also advanced the College’s quality initiatives (via Q&S efforts) by advocating federal legislation mandating accreditation. This happened initially for mammography, with the Mammography Quality Standards Act in 1992, achieved with excellent support by the Komen Foundation and other patient groups.4 It happened subsequently in “advanced imaging” via the Medicare Improvement and Patient Protection Act (MIPPA) legislation in 2008.5 These important quality initiatives, championed by the ACR, give patients the assurance they deserve that high-quality imaging will occur when they need it.
What are the biggest issues now facing the ACR and its partners, and do you think we are making adequate progress?
Though there are many issues on the ACR’s plate, let me concentrate on two.
First, there is a significant shortage of radiologists, radiologic technologists and ancillary radiology personnel.6 For radiologists, the number of CMS-funded residency slots is essentially fixed, and we all know that the work volume (both in numbers and complexity of exams) is increasing. This impacts all radiology sub-specialties and is probably most notable in “general radiologists” in rural and underserved communities. This leads to diminished access to our indispensable services as well as radiologist burnout and will take a profession-wide collaborative and creative effort to find solutions.
Second is the constraint imposed on physician reimbursement by the “budget neutrality” provision in the Medicare statute. While all costs of providing care rise year after year, and reimbursement to hospitals and others rises via their respective programs, physi-cians live in a “fixed pie” world. We all know there needs to be an overhaul of the physician payment process, focusing on value rather than volume. The College is constantly working collaboratively with other specialties, legislators and regulators to design that system of the future, but in the short term during that transition, there needs to be some relief to ensure widespread equitable access to radiological care that contributes to virtually every significant episode of care as well as population health.
What makes the ACR’s approach to collaboration unique?
The ACR is truly unique in our experience and innovation. Our long history of developing our IT capabilities — most recently with the ACR Data Science Institute® and ACR Connect® — and coordinated multicenter collaboration through initiatives like ACR research, registries and the AI-Lab™ provide us with infrastructure that is unlike any other specialty society. These make the College a very desirable partner. In addition, as stated above, radiology is integral to the care of virtually all patients. In the era of team-based healthcare, we have a tremendous amount to offer.