The ACR's Significant Achievements and
Programs
1987 to 2001
The period from 1987 to the present was marked by unprecedented growth and achievement. The ACR increased the scope of its services to better promote and advance the profession. Here are just some of the achievements and programs during this period.
Government Relations: In 1987, the ACR had three employees working on government relations; today there are 10. These additions have helped the ACR attain a greater presence on Capitol Hill and at the regulatory agencies. Some of the major achievements and programs include:
Defeat of efforts to pay hospitals for the professional services of radiologists, anesthesiologists and pathologists by diagnosis related groups (known as RAPs-DRG). The RAPs proposal would have had a devastating impact on the income of a radiologist in a hospital.
Work with Congress to pass a provision singling out radiology for its own Relative Value Scale (RVS) for reimbursement purposes under Medicare. This valuation method serves as a basis for the radiology portion of the resource-based RVS (RBRVS) used by Medicare today. This ACR initiative has served the College very well over the years, both with Congress and HCFA.
Work with Congress to ensure quality in mammography services and reimbursement. Efforts are currently under way in Congress to increase the reimbursement for mammography procedures.
Work with Congress to defeat physician self-referral legislation. The ACR continues to work on this issue to ensure that Congress does not pass self-referral legislation in the future.
Work with state chapters to pass legislation on
subjects of importance to radiology such
as telemedicine.
Formation of a political advocacy organization, the Radiology Advocacy Alliance, which subsequently formed RADPAC (Radiology Political Action Committee). Contributions from RADPAC totaling $418,000 in three years have given the ACR the opportunity to discuss issues of concern to radiology with influential legislators.
Ongoing work with the Nuclear Regulatory Commission, the Food and Drug Administration and state regulatory bodies on regulations of importance to the practice of radiology.
Work with Congress on the passage of the new National Institute for Biomedical Imaging and Bioengineering.
Economics: The ACR' s economics
department has grown from one professional staff member
to 12 in the past 14
years as Medicare, billing, managed care and reimbursement has become more
complicated. The ACR's greater involvement in economic issues has had a positive
impact for radiology of several million dollars over the years. Some of the
major achievements and programs include:
Strong ACR representation on the RVS Update Committee (RUC) and Practice Expense Committee (PEAC). ACR members and staff spend countless hours surveying, presenting, reviewing and commenting on important valuation processes. The ACR's accomplishments in maintaining the appropriate relative values for diagnostic radiology, radiation oncology, nuclear medicine and interventional radiology have proven invaluable to the profession.
Continuous ACR efforts to ensure that the values for diagnostic radiology and all the subspecialities of radiology and the relativity of the original radiology fee schedule are maintained.
ACR coordination of the networks of radiologists who serve on their Medicare Carrier Advisory Committees (CAC). The ACR and CAC members review and comment on Local Medical Review Policies (LMRPs). Reimbursement of ACR members is directly related to the content of LMRPs. The CAC activity of the ACR is vitally important to the ACR membership. Ninety percent of all Medicare policy is written at the local level, and the ACR has been instrumental in ensuring that all policies appropriately cover diagnostic radiology and other radiology subspecialty procedures.
Involvement by the ACR Committee on Coding and Nomenclature in new code development for the CPT Editorial Panel. The continued presence of a radiologist on the editorial panel has been extremely beneficial to radiology. The ACR has worked with radiology subspecialties to obtain the codes from the panel needed for radiation oncology, interventional radiology, ultrasound and nuclear medicine subspecialties.
Continuous and fruitful ACR work on many new
radiology codes. The ACR economics
department handles over a hundred calls
per week from ACR members.
Defeat of the original HCF A manual transmission 1200 relating to radiation oncology. Enactment of this transmission would have had a major negative impact on the practice of radiation oncology. Negotiations between the ACR and HCFA brought the issue to a positive conclusion for radiation oncology.
Current work with HCFA on proper valuation of diagnostic and screening mammography. HCFA has recently announced a 15% increase in the physician work value for bilateral diagnostic mammography.
Ongoing work with HCF A to obtain expanded reimbursement for the nuclear medicine procedure, PET. This effort continues so that PET procedures using appropriate equipment are reimbursed.
ACR review and comment on the correct coding initiative (CCI). Representatives from the Commission on Economics fought the implementation of the "black box" edits. As a direct result of ACR input, HCFA no longer purchases these types of edits. Implementation of "black box" edits would have had a serious adverse impact on quality patient care and all radiology subspecialities.
ACR review, analysis and comment on Medicare regulatory issues such as Ambulatory Payment Classifications (APCs), X-rays interpreted in the emergency room, teaching physician rules, the ordering physician rule and supervision regulations. The ACR continues to work on all these issues. The newly created HCFA APC Advisory Committee includes two members who are radiologists.
Shift of ACR focus to the local level with the development of the ACR Managed Care Network and the ACR Managed Care Committee. The goal, as always, is to advance quality patient care while achieving fair reimbursement for radiologists.
Quality Delivery of Radiological Care: The ACR is a nationally recognized leader in the field of accreditation and developing standards for imaging. The College has provided the staff support to the committees, task forces and leadership for the development and implementation of the following quality assurance products and activities. A highly qualified staff with expertise in every area of diagnostic and therapeutic radiology provides information and assistance to ACR members and their staffs regarding quality patient imaging and treatment. Some of the major achievements and programs include:
Publication of radiology standards that provide very good risk management tools.
Development and publication of BIRADS ™
(three
editions). This lexicon and reporting
system is used throughout the world
for the interpretation of mammography and is being expanded for use in breast
ultrasound and MRI. It is a major resource to radiologists and referring
physicians.
ACR leadership in the effort to provide guidelines that included mammography screening for women 40-49 years of age and continued monitoring of possible changes.
Participation in the development of a federal effort for a National Strategic Plan for the Early Detection and Control of Breast and Cervical Cancer.
Coordination of the activities of the ACR/CDC Cooperative Agreement for Quality Assurance Activities in Mammography, funded to provide educational outreach for professional education.
Creation of the Continuous Quality Improvement Manual for Diagnostic Radiology, which helps practices develop quality assurance activities.
Development of quality control manuals for mammography (four editions), barium enema, stereotactic breast biopsy and MRI.
Implementation of seven accreditation programs (with an additional three to be completed this year).
Development of videos to guide facilities through the accreditation process for MRI, ultrasound, nuclear medicine and radiation oncology.
Recognition of the ACR mammography accreditation program by the FDA under MQSA. It is the only national accreditation program so recognized.
Provision of lists of ACR-accredited facilities to physicians and patient referral organizations.
Participation as specialty society liaisons to the National Quality Forum, JCAHO, Agency for Healthcare Research and Quality (AHRQ).
Clinical Trials/Research: The NCI-funded research activities of the Philadelphia ACR office involve almost 300 institutions and provide the scientific basis for future diagnostic imaging and therapeutic oncology regimes. This research conducted by radiologists and radiation oncologists ensures their future involvement and control of the disciplines.
Since 1975 the American College of Radiology has had responsibility for administering the Radiation Therapy Oncology Groups (RTOG). RTOG is a preeminent, multidisciplinary radiation therapy cancer research group committed to improving the outcomes of adults with cancer by providing loco-regional control and providing enhanced quality of life. Because of its many years of NCI self-supporting funding, the activities and available grant funds have increased significantly.
Since 1999, the ACR has also had administrative responsibility for the American College of Radiology Imaging Network (ACRIN). This cooperative group seeks to advance diagnostic imaging and imaging-guided interventional procedures through clinical trials. This grant will provide a major new source of research funding for diagnostic imaging. Further, significant funds recently have been added to conduct the full-field digital mammography trial.
Current Significant Task Forces: Several task forces are addressing current significant issues in radiology and gathering information to prepare us to properly manage future ones. These include:
Task Force on Human Resources -This task force was established at the request of the Council to address the medical workforce shortage that includes radiologists, radiation oncologists, imaging technologists, radiation therapists and medical physicists.
Task Force on Molecular Imaging -This task force was established to investigate issues surrounding this technology and insure that it is appropriately included in radiological imaging.
Task Force on New Screening Technologies -This task force was established to investigate the efficacy, manpower and economic implications of these new radiological screening technologies.
Task Force on Mammography Practice Issues -This task force was established to investigate the medico-legal and economic issues surrounding mammography practice.
Task Force on Patient Safety -This task force was established to respond to issues raised in the Institute of Medicine report on medical errors.
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Department of Radiology
School of Medicine
State University of New York at Stony Brook
Health Sciences Center