How Radiology Maintains Relative Value Units But Could Lose Big in Reimbursement: The Power of the Conversion  Factor

Within health care reform, it is widely accepted that primary care practice transformation and delivery are essential  to achieving the nation’s quadruple aim—improving patient and provider experience and the health of the population while decreasing cost. Although accountable care organizations and alternative payment models have been lauded as the summit of this proverbial value escalator [1], much of our cu rrent health care system can be found at lower levels on the ascent [2]. For those who are not there yet, how does CMS adjust how primary care services are paid in a fee-for-service environment to incentivize preventive care? And, lest our readers worry they have picked up the wrong journal, how do these reimbursement adjustments affect radiologists and the patients for whom we provide care? The answer begins with a tour of the reimbursement process using office visit codes as an example and ends with a recent Medicare policy that will result in a significant impact on payment for radiology s ervices beginning in 2021.
Source: Journal of the American College of Radiology : JACR - Category: Radiology Authors: Tags: Opinion Source Type: research