Tuesday, December 20, 2016


The U.S Centers for Medicare and Medicaid Services will likely (and hopefully) delay the mandatory adherence to MACRA/ MIPS.  If you don’t know what MACRA and/or MIPS is don’t worry, you are not alone. In fact, 90% of surveyed Radiologists aren’t familiar with it and further more, of the 10% that know what it is, only 10% of them have actually began the necessary steps to implement the system.  Essentially, the services we provide starting in January 2017 will become part of the composite performance score that will determine our payments in 2019.

In a extremely simplified nut shell, it is an intricate value - based payment system that requires numerous checks to evaluate the “value” of what we do and our involvement in overall patient care.  MACRA is meant to consolidate alternative payment models and quality incentive initiatives into a single framework. The and advanced alternative payment models (APMs).

Most radiologists will participate in the program through the Merit-Based Incentive Payment System (MIPS), which is a 100-point system that consists of four performance categories:


            •           Quality (50 points)

            •           Cost (10 points)

            •           Clinical practice improvement activities (15 points)

            •           Advancing care information (25 points)

These performance category scores will be combined into a total score, which will then be compared to a performance threshold to determine whether clinicians will receive an upward or downward payment adjustment.

Our fee for service payments are soon to be a thing of the past and our reimbursements will be mainly based on this new system.  It will be extremely cumbersome as it is essentially an EMR system that we input data into regarding our contribution to the patients care.  It will be cost and time consuming but it is our future and we need to get acquainted with it or we will be scrambling once implemented.  It may surprise you to hear there is a soft roll out of this system supposedly beginning in 2017 with mandatory involvement by 2018 but with the election results, this might be delayed.  Thankfully, we have the ACR supporting radiologists and have an aggregate of resources on their website in an effort to help us navigate through this complex paradigm shift.

The truth is, we do not have a clear idea of what will happen.  Although President-Elect Trump was the GOP nominee he is not the traditional Republican and therefore his actions are rather unpredictable.  Although the transition to a Republican legislation may slow this adaptation, the appointment of Seema Verma as the head of CMS will likely expedite the performance-pay system in an effort to decrease CMS expenditures. 

Author: SuperUser121

Categories: LegislationNumber of views: 4748


Theme picker

Enter Title

The purpose of this page is to inform SBI members about legislative updates that impact breast imaging and breast imagers. Dr. Nicole Saphier will be contributing and providing the posts on a quarterly basis. 

About Nicole B. Saphier, MD: 

I am a board certified radiologist with fellowship training in Oncologic Imaging and am the Director of Breast Imaging at Memorial Sloan Kettering Monmouth facility. I see patients at MSK in New York City as well as at MSK Monmouth New Jersey with my primary clinical focus of breast imaging and intervention, including mammography, breast ultrasound, and breast MRI.

In addition to breast imaging, I am active in healthcare leadership, policy, and advocacy at local and national levels as well as holding a seat on the RADPAC board. Although I see many patients every year, being involved in advocacy and legislation allows me to reach infinitely more. I am also the creator of the Twitter hashtag #RadsHaveAFace which I developed in an effort to bring radiologists out of the dark and into the light in our rapidly changing healthcare paradigm.