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New Study Gives Insight in Patient Complexity Across the Radiology Field

Out of all the specialties, radiologists see the country’s most “clinically complex” patients says a study recently published in Academic Radiology.

A group of researchers led by Andrew B. Rosenkrantz, MD, MPA, associate professor of radiology and director of health policy at New York University Langone Health, evaluated Medicare patient data from 31,175 radiologists across the U.S to “identify radiologist characteristics associated with higher patient complexity.”

The researchers found that interventional radiology ranked fourth out of 54 specialties on the Hierarchical Condition Category (HCC) risk score. Nuclear medicine came in 16th place and diagnostic radiology at 21st. Patients of academic radiologists and radiologists based in urban practices had higher complexity risk scores than those who worked in rural areas, nonteaching hospitals, and large clinics with 100 practitioners or more. Across noninterventional specialties, cardiothoracic radiologists experienced the highest patient complexity and breast imagers had the lowest.

The study was conducted in part to determine the outcome of the soon-to-be-implemented Medicare Access and CHIP Reauthorization Act (MACRA). Although the legislation was signed into law in 2015, it’s set to affect physician payment rewards systems next year. The act introduces the Merit-based Incentive Payment Service (MIPS), which has the power to impact a radiologist’s payment models through the Centers for Medicare and Medicaid’s (CMS) performance assessment.

According to the study, radiologists are on track to receive payments that are skewed to be more value-based. “Physicians caring for sicker patients, as may be anticipated among university and other tertiary care centers, will be challenged in obtaining the same clinical outcomes and resource utilization as those caring for healthier patients,” wrote the researchers. “Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment.”

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