Identifying Radiology's Place in the Expanding Landscape of Episode Payment Models

The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs. Early models with relevance to radiologists include Bundled Payment for Care Improvement (involving 48 possible clinical conditions), Comprehensive Care for Joint Replacement (involving knee and hip replacement), and the Oncology Care Model (involving chemotherapy). In July 2016, CMS expanded the range of EPMs through three new models with mandatory hospital participation addressing inpatient and 90-day postdischarge care for acute myocardial infarction, coronary artery bypass graft, and surgical hip and femur fracture treatment. Moreover, some of the EPMs include tracks that allow participating entities to qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA), reaping the associated reporting and payment benefits. Even though none of the available EPMs are radiology specific, the models will nevertheless likely influence reimbursements for some radiologists. Thus, radiologists should partner with hospitals and other specialties in care coordination through these episode-based initiatives, thereby having opportunities to apply their imaging expertise to help lower spending while improving quality and overall levels of health.