More Related Content
What's hot
What's hot (20)
Similar to Rybicki Slides RSNA 2019 Reimbursement
Similar to Rybicki Slides RSNA 2019 Reimbursement (20)
Recently uploaded
Recently uploaded (20)
Rybicki Slides RSNA 2019 Reimbursement
- 1. FRANK J. RYBICKI MD, PhD Reimbursement Roadmap for Anatomic Models Vice Chair Operations & Quality, Dept of Radiology | University of Cincinnati
- 2. DISCLOSURE Frank J. Rybicki is the Director of Medical Affairs at Imagia M I C H E L A N G E L O “Rondanini Pietà” Milan, Italy
- 3. OUR IDENTITY We are health care providers and industry members who practice, teach, and produce scholarship regarding the conversion of anatomic and other medical data into digital representations, followed by anatomic models and anatomic guides. Our work requires proper oversight, quality and safety standards, and fair reimbursement with the overall goal of adding medical value for those patients with appropriate clinical scenarios for 3D printing plus virtual and augmented reality. OUR GOAL
- 4. Anatomic medical data conversion to digital representations and physical models and guides Our Identity Medical value added Demonstrate scholarship Proper oversight Teach Fair reimbursement Quality and safety standards Appropriateness Contemporary Issues in 3D Printing, RSNA 2018 Frank J. Rybicki MD, PhD
- 6. FAIR REIMBURSEMENT 1796, BOSTON Gilbert Stewart Museum of Fine Art I hope I shall possess firmness and virtue enough to maintain what I consider the most enviable of all titles, the character of an honest man. “ “ — George Washington
- 7. How a Dictation Becomes a Dollar 7 Mark Alson, MD, FACR, RCC Chairman, ACR Economics Committee on Coding and Nomenclature Zeke Silva III, MD, FACR, RCC Chairman, ACR Commission on Economics The next 13 slides are borrowed & adopted from the following:
- 8. ▪ Current Procedural Terminology (CPT®) ▪ National standard code set to bill procedures/services to Medicare and other third-party payers ▪ Listing of descriptive terms and identifying 5-digit numeric codes for reporting medical services and procedures, e.g., 71020 CXR 2 view, frontal and lateral ▪ Purpose: to provide a uniform language that accurately describes medical, surgical, and diagnostic services ▪ Serves as an effective means for reliable nationwide communication among physicians and other healthcare providers, patients, and third parties Strategy Nomenclature Codes
- 9. Category I ▪ Widespread use ▪ Peer reviewed literature ▪ Advisorsupport ▪ Referred toAMA-RUC forvaluation Category II ▪ supplemental tracking codes usedforperformance measurement Category III ▪ Limiteddissemination ▪ Literature suggests future growthand utility ▪ Primarily fortracking newprocedures ▪ NOTreferred toAMA-RUCfor valuation ▪ Contractor priced ifcovered TYPES OF CODES
- 10. ▪ Responsible for maintaining the CPT code set ▪ Authorized by AMA Board of Trustees to revise, update, or modify CPT codes, descriptors, rules and guidelines ▪ Current radiologist on panel is Zeke Silva ▪ Importance of your medical societies CPT EDITORIAL PANEL
- 11. EXAMS FAMILIAR TO RADIOLOGISTS 11 71010 70551
- 12. 12
- 13. What is an RVU? 13
- 14. American Medical Association Specialty Society R Relative Value Scale U Update C Committee R Resource B Based R Relative V Value S Scale 14
- 16. RVU 16 0.2 RVUs 2 RVUs
- 17. TOTAL RVU 17 Practice Expense (TC) + Physician Work (PC)
- 18. 18 GPCI = x Geographical Pricing Cost Index Conversion Factor
- 20. SCHOLARSHIP
- 21. HOW ARE WE GOING TO GET REIMBURSEMENT TO EARN FAIR REIMBURSEMENT, PROFESSIONALS NEED SCHOLARSHIP & THAT SCHOLARSHIP MUST DEMONSTRATE VALUE. WE MUST ALSO SHOW THAT MANY PHYSICIANS ARE PROVIDING THAT VALUE TO OUR PATIENTS
- 22. SCHOLARSHIP 200 year anniversary of NEJM Pomahac B et al. NEJM 2012
- 23. Peter Liacouras
- 24. REGISTRY ANALYSES 15+centers 3+ continent contributions PATHWAY TO CAT I CODE: Basic questions to be published: Models are generated by many physicians, receive CPT Category III code (where applicable), and found beneficial for clinical care. Benefit determined by metrics captured in registry. Benefit to clinical care can be “in the eye of the beholder”, but ideally to include the end-interventionalist (surgeon or the person who uses a guide). This paper should include all care providers Registry data will include all relevant data required for a major publication (journal IF > 15). This is why a few simple questions will never work.
- 25. PATHWAY TO CAT I CODE: Hypotheses tested and validated: 3D printed anatomic models had a measurable, statistically significant enhancement to patient management and outcome 1 3D printing guide (where applicable) was accurately produced and made a statistically significant improvement in the intervention 2 Follow-up data on outcomes is being assessed to show 3 and 5-year benefits of guides/ implants for a collection of procedures 3 MULTI- CENTER trial based NORTH AMERICA 5+ centers 3-4 continent contributions APPROPRIATE CLINICAL SCENARIO Taken from SIG Guidelines
- 26. EDUCATION
- 28. PROPER OVERSIGHT
- 29. RESPONSIBILITY OF THE SIG www.fda.gov Andy Christensen
- 30. INDUSTRY VERSUS IN-HOSPITAL PRACTICE Regulatory bodies (e.g. FDA) tightly manages industry approach to medical 3D printing State (medical board) and local (hospital privileges) management of the practice of medicine in hospital FDA INDUSTRY ?? HOSPITAL Rybicki FJ. The Lancet, 2018
- 32. QUALITY AND SAFETY STANDARDS Source: www.acr.org
- 33. APPROPRIATENESS
- 34. VALUE ADDED REQUIRES DEFINITION OF WHAT DATA SHOULD OR SHOULD NOT BE CONVERTED VIA 3D PRINTING AND/OR VR - AR Table 1 Ratings Summary: Appropriateness Guidelines for patients who present with a variety of medical conditions, and for whom 3D Printing may be considered. Chepelev et al. 3D Printing in Medicine (2018) 4:11 Double Outlet Right Ventricle Dentofacial Anomalies including Malocclusion Malignant Bone Neoplasms Genitourinary Neoplasms Vascular Malformations Complex Acetabular Fractures NO DATA on Guides
- 35. Nicole Wake Justin Ryan HISTORY IS IMPORANT But it won’t pay the bills
- 36. Don’t touch it! It’s perfect!Michelangelo “David” 1501-4 Galleria dell’Academia, Florence