While the history of healthcare reimbursement modeling is beyond the scope of this article, all healthcare workers should recognize that we are about to embark upon a marked change in the strategy of healthcare delivery. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was enacted with huge bipartisan support. This was done in an attempt to balance the growing economic burden of an aging population with the delivery of high quality healthcare to these patients. The reimbursement strategies for the Centers for Medicare & Medicaid Services (CMS) will be shifting from the volume (fee for service) model to a value–based care model. Value in healthcare is defined as outcomes achieved per dollar spent. This reimbursement model of value-based care will likely cause a paradigm shift in our patient care model.
Echocardiography has been a fundamental diagnostic tool in cardiology for several decades. Although we know echo has proven to be safe and relatively inexpensive, we have to demonstrate the value of echo in order to maintain our place in cardiovascular imaging. Our profession has been instrumental in defining the recommended quality standards for echo lab operations. The development of a comprehensive set of Guidelines and Standards make echo a reproducible and reliable technique to quantitatively assess cardiovascular health. The cardiovascular imaging community developed appropriate use criteria for echocardiography to help facilitate the wise use of our healthcare resources. They also supported the American Board of Internal Medicine’s Choosing Wisely campaign. Our profession has already embraced these fundamental steps to promote value-based care.
With the implementation of MACRA, expect more changes to appear in the echo lab landscape. Providers will be scored on their use of resources as well as other quality measures by the Quality and Resource Use Report (QRUR). This will be publicly available online and will directly affect the rate of reimbursement for more than 90% of all providers by 2019. The indirect result of this will likely be an increasing demand from the providers for high quality imaging standards within the echo lab. While quality improvement (QI) initiatives are a requirement for lab accreditation, expect an intensified focus in the future. This will include benchmarking, where a lab sets a level of excellence they want to measure themselves against. Benchmarking will include data collection and comparison of the processes and performance measures in the lab. Examples might be measuring the percentage of suboptimal studies or adherence to the lab protocols. There will be a greater emphasis on increasing our quality metrics and turning out quantifiable and reliable studies. In turn, these high standards will serve as a countermeasure to the current productivity pressures that many sonographers and labs are currently experiencing. While the foundation for value-based care has been carefully laid by our profession, the individual sonographer’s skill and effort remain pivotal variables effecting image quality.
As Blackberry can attest, a solid history is not a guarantee for the future. Blackberry had a very robust history as a unique leader in communication tools for business. In 2007, Blackberry was one of the first widely used “smart devices,” garnering 85 million subscribers eventually. Supreme security and reliability fostered a virtual dependency on this device for many business men and women. Today they are trying to reenter the market after their technology was rapidly surpassed by smart phones. Their current product is struggling to survive, much less stand out as a front runner. What was once essential and fundamental in the business world rapidly became obsolete due to Blackberry’s lack of vision and innovation.
The fee-for-service environment has fostered an emphasis of volume over quality. The paradigm shift will be from productivity counts to making each echo count. Producing consistent high quality images for quantification will become a high priority in the new post MACRA landscape. Actively engaging in QI initiatives, meeting benchmark standards, and embracing innovations in the field will prevent echo from following Blackberry’s lead. Partnering with your providers to participate in optimal patient care will foster a culture of excellence and improve job satisfaction in the echo lab. Sonographers now have an opportunity to help ensure that echocardiography remains relevant in value-based medical care. I leave this golden opportunity in your safe and capable hands.
Hollie Carron, AAS, RDCS, FASE began her career in adult, pediatric, and fetal echocardiography in 1981. She has served as adjunct faculty and clinical instructor at El Centro College’s Pediatric Echo Program. She is currently the Education Coordinator of the Pediatric Echo Laboratory at Children’s Mercy Hospital in Kansas City, Missouri. Hollie is actively involved in the ASE’s Advocacy Committee and Sonographer Council.