With the final Medicare Access and Chip Reauthorization Act
(MACRA) rules expected in October, RBMA members gathered in New Orleans at the
last RBMA Fall Educational Conference to learn all they could about what
challenges may lie ahead and how to face them.
The tone for the day was set by Zubin Damania, M.D., better known
by his alter ego ZDogg MD, a medical humor rapper and song satirist. His
Facebook page has more than 300,000 followers and his YouTube videos have
received more than a million views.
ZDogg was the keynote speaker, which at first blush might seem an
odd choice, but his message about the need to survive a data and metrics
obsessed Health 2.0 world in order to get to Health 3.0 — where technology will
serve not dictate patient care — really resonated with the audience or
radiology business owners and managers.
Dr. Damania, in addition to being an internet celebrity, is one
of a small handful of primary care physicians in the country experimenting with
Health 3.0 in a Health 2.0 world. Turntable Health, the clinic he founded in
Las Vegas, strives to offer what he terms re-personalized medicine. It is
high-touch health care like the old-school Health 1.0 medicine his father
delivered, but it also uses advanced Health 2.0 technology, electronic medical
records and new concepts like mindfulness and health coaching to connect with
patients. Turntable can experiment in this way because it gets a flat fee per
patient and succeeds when its patients stay healthy. But it is no “cake walk,”
Dr. Damania said.
“Health 3.0 is where we are trying to get to and you guys
[administrators], are a critical part of how we will get there,” he said.
The booming laugh of RBMA past president Keith Chew, FRBMA, rang
above the crowd with each of ZDogg’s three live musical performance. But after
the presentation, he too expressed frustration with the failings of Health 2.0.
“The IT guys run the show and they don’t want to let anyone connect to their
systems,” Chew said.
As a result practice administrators are stuck with the unenviable
tasks of pushing their radiologists to spend time optimizing documentation for
billing purposes and not patient care, as well as explaining why easily moving
information and images across platforms often remains frustratingly out of
reach when retail industries they interact with every day make interoperability
seem so seamless and easy.
Following Dr. Damania’s presentation, RBMA members headed into
the concurrent sessions, the most popular of which was “Preparing Radiology for
Physician-Focused Payment Models” presented by Robert Bradner, JD, and Miranda
Franco of the Washington, D.C., office of Holland & Knight.
“The government wants to pay by episode of care,” Bradner
explained to an overflow crowd. Bundled payments, like those created for joint
replacement and cardiac care, will become more common and providers will need
to share more risk with payors.
With time running out on the present administration, there is
definite pressure to put regulations in place that advance this goal of shared
risk, Bradner and Franco explained. However, as the government moves to release
the final MACRA regulations, it is also getting push back that it is moving
ahead too quickly and threatening the survival of all but the very largest and
most sophisticated practices that are ready to move to capitated payment
Whether practices will get a reprieve and be able to report
partially instead of a full year of data under MACRA, as Andy Slavitt, acting
administrator at the Centers for Medicare and Medicaid, promised in a hearing a
week ago, is still unknown. However, evidence of the fallout from the
move toward more shared-risk payment models was already showing up in the RBMA
Imaging Center Roundtable discussion later that afternoon. For example, many
hospitals, which CMS is putting on the hook in bundled payment scenarios, are
no longer signing professional service agreements with independent radiology groups
and are sometimes strongly pressuring groups to sell to the hospital,
roundtable discussion attendees reported.
“Integration is their favorite word,” one attendee remarked
Where this will all lead, no one yet knows. However, Dr. Damania
predicted that the fight to get from Health 2.0 to Health 3.0 would be as great
and as important as any in U.S. history. “This is the defining challenge of our
era,” he said.