Pam Kassing, senior economic advisor, ACR

As the health care model continues to undergo significant reform, one of the biggest legislative changes comes from the Patient Protection and Affordable Care Act (PPACA) of 2010. The legislation calls for the formation of accountable care organizations (ACOs), which look to significantly change the way health care is delivered and providers receive compensation.

ACOs are networks of providers, including specialists and primary care physicians, that undertake health care delivery to a patient population. Each ACO will have a minimum of 5,000 Medicare beneficiaries to whom they deliver health care services. And while that may seem like a fair benchmark, the inability to choose that group of beneficiaries is one of the primary complaints of the model.

“I suppose the biggest risk is that there is no defined group of beneficiaries that would be assigned to the accountable care organization,” said Pam Kassing, American College of Radiology (ACR) senior economic advisor. “So if you are signing up to participate for an ACO as a provider, you would have to sign a 3-year contract. When you are signing a 3-year contract, you hope that you will share savings—that there will be savings—but you also share in the risk. The way that Medicare is proposing to set up the ACOs, especially without giving a defined population, is a major concern.”

There are other concerns—such as ensuring that radiologists are included in the front end of the diagnostic process—that the ACR recently addressed in its comments on the proposed legislation. But in an effort to reduce strain on the imaging community, the ACR has released a white paper, “Strategies for Radiologists in the Era of Health Care Reform and Accountable Care Organizations,” which is available through the Journal of the American College of Radiology, to assist radiologists with the transition to the ACO model.

“The white paper was in preparation for the ACO rule coming out and being put into place,” said Kassing. “A lot of our members have asked the ACR, ‘How do I get ready for accountable care organizations and other payment models? What do we need to do to get prepared?’ The basic communication that we send out in that paper is that radiologists have a lot to bring to the table, that imaging plays a vital role in just about every disease state and patient condition, and that radiologists should step up and show that they play this important role and that they’re value added.”

Not all of the prospects surrounding ACOs are negative. For example, radiologists are allowed to participate in more than one ACO, allowing them to have a broader beneficiary base, thus reducing risk. But with significant change comes significant responsibility, and the ACR is doing everything it can to ensure that radiologists are prepared for the coming legislative changes.

“As the initiative moves forward, we’ll keep following it and reporting on it, and letting our ACR members know at least the ACR’s position on it,” said Kassing. “We hope that it’s the position of most of the radiologists in the country, since we represent 34,000 radiologists. We are working on different types of payment models for physicians, and we hope to get that out to the membership and on our Web site as well. So the paper was just the first in a series of projects that we’re working on for the membership.”