Background: The economics of health care and payment policy are complex and continually evolving. Breast imagers may not feel equipped to understand this aspect of their practice. However, without core knowledge of payment policy, a breast imager’s ability to advocate for breast health, screening, and access for their patients is stunted. At the most basic level, breast imagers should be able to describe the mechanisms of reimbursement and progress to advocating or leading systems change that enhance high-value, efficient, and effective patient care. While healthcare payment policy is highly complex, this educational exhibit seeks to identify and educate on key competencies that breast imagers should acquire.
Learning Objectives: 1. Learn who the key players are in payment policy 2. Understand what components make up physician reimbursement 3. Begin to conceptualize how payment policy can impact patient access and “compliance” with screening and diagnostic breast imaging
Abstract Content/Results: Presentation of non-interpretive skills
Presentation Outline: Payors - Insurance Medicare - CMS (Centers for Medicare and Medicaid Services) RVU (Relative Value Unit) - Components -- Work -- Practice expense -- Professional liability Conversion Factor Geographic practice cost index The concept of a fixed pie Process and timeline - AMA CPT (Current Procedural Terminology) - RUC Advisory Committee - Relative Value Scale Update Committee (RUC) - Proposed Rule - Final Rule What does this mean for screening mammography? What does this mean for diagnostic breast imaging? US? MRI? Breast imagers as advocates
Conclusion: Payment policy is a component of a large complex healthcare system. To better navigate the healthcare system for themselves and their patients, breast imagers must learn the fundamental concepts of payment policy.
.jpg "Connie M. Lu, MD photo")