2017 James M. Moorefield Fellow in Economics & Health Policy€¦ · 2015-Present: Radiation Oncology Residency at UT Southwestern - ACR RFS Economics Advisory Group - 2017 Moorefield

2017 James M. Moorefield Fellow inEconomics & Health Policy

Ryan T. Jones, M.D.PGY-4 Radiation Oncology

UT Southwestern

Overview

2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 2

Personal Background

Economic History of the American Healthcare SystemWhere we’ve been and where we are

How the ACR is helping shape our futureFocus on Economics & Health Policy


Hometown: Rural VA, poor access to quality healthcare

2006-2014: Undergraduate & Medical School at UVA- Internship, UVA Cancer Center Administration- Rapid radiotherapy workflow project, safety analysis- Entrepreneurial pursuit to reduce hospital readmissions

Residency Interviews: Payment reform need identified

Internship: Internal Medicine/ Ebola management at Presby Dallas

2015-Present: Radiation Oncology Residency at UT Southwestern- ACR RFS Economics Advisory Group- 2017 Moorefield Fellow

- TRS Economics & Practice Committee- ACR MACRA Committee

- MBA in Healthcare Leadership & Management

Personal Background

The American Healthcare System


1910s

1920s

1929

1930s

1939

1940s

1965

Worker’s Comp/ “sickness” insurance for lost wagesOpposition to health insurance from doctors, labor, and businessFailed attempt by TR for national health insurance

Hospital medical costs exceed wage losses Insurance shifts to cover cost rather than wages

Baylor Hospital of Dallas offers teachers hospital insurance for $6.00/year (becomes Blue Cross) = the first group health insurance

Failed attempt by FDR for national health insurance

California Medical Association starts Blue Shield

WWII wage freeze prompts employee benefits (employer health ins)

LBJ: Medicare & Medicaid



1910s

1920s

1929

1930s

1939

1940s

1965










1910s

1920s

1929

1930s

1939

1940s

1965










1910s

1920s

1929

1930s

1939

1940s

1965










1910s

1920s

1929

1930s

1939

1940s

1965









1973

1970s

1980s

1990s

1999

2003-2014

2010

2014

2015

HMO Act

HMO enrollment is slow

DRGs

RBRVSPeak of managed careManaged care backlash

SGR; IOM “To Err is Human”

SGR repeatedly overridden

PPACA

Potential SGR payment reduction 21%Movement towards value based purchasing

MACRA

14.5%

11.2%

4.5%

8.5%

3.1%

13.5%

3.2%1.9% 2.6%

0%

5%

10%

15%

0

1000

2000

3000Total NHE (billions)2016 Dollars (billions)

Source: Center for Medicare & Medicaid Services


1973

1970s

1980s

1990s

1999

2003-2014

2010

2014

2015

HMO Act


DRGs




PPACA


MACRA

14.5%

11.2%

4.5%

8.5%

3.1%

13.5%

3.2%1.9%

2.6%0%

5%

10%

15%

0

1000

2000




1973

1970s

1980s

1990s

1999

2003-2014

2010

2014

2015

HMO Act


DRGs




PPACA


MACRA

14.5%

11.2%

4.5%

8.5%

3.1%

13.5%

3.2%1.9%

2.6%0%

5%

10%

15%

0

1000

2000




1973

1970s

1980s

1990s

1999

2003-2014

2010

2014

2015

HMO Act


DRGs




PPACA


MACRA

14.5%

11.2%

4.5%

8.5%

3.1%

13.5%

3.2%1.9%

2.6%0%

5%

10%

15%

0

1000

2000




1973

1970s

1980s

1990s

1999

2003-2014

2010

2014

2015

HMO Act


DRGs




PPACA


MACRA

14.5%

11.2%

4.5%

8.5%

3.1%

13.5%

3.2%1.9%

2.6%0%

5%

10%

15%

0

1000

2000



~18% of GDP

MACRA


MIPS APMOR

Extends CHIPRepeals SGR

Shifts FFS to P4P

Value-based payment for physicians, not hospitals

MACRA


MIPS APMOR

PQRS VBPM MU

= Cost


Shifts FFS to P4P

MACRA


MIPS APMOR

PQRS VBPM MU

= Cost

Composite Score (2018): 50% 10% 15% 25%


Shifts FFS to P4P

MACRA


MIPS APMOR

ACOs Shared RiskBundled Payments


Shifts FFS to P4P

Economics & Health Policy Department


Examples of their impact:

- Lead proposals to CMS for new & modified CPT codes and APC bundlesDuring my trip: (1) MR Elastography and (2) US w contrast

- Lead RUC-based work on valuation of CPT codes

- Monitor health policy changes and respond quickly to payers on behalf of stakeholdersDuring my trip: (1) Review of MedPAC 2017 meeting and (2) 2018 meeting

(3) Presentation at CMS headquarters regarding DOS in Radiology(4) Letter to Novitas regarding coverage of spacer gel(5) Visit to Government Relations office in DC

- Keep members informed of changes in the economic landscapeDuring my trip: New Clinical Examples publication to teach proper CPT coding

- Staff the numerous committees in the Commission on Economics




























Commission on Economics


Economics Committee on Body ImagingEconomics Committee on Breast ImagingEconomics Committee on Coding & NomenclatureEconomics Committee on Economic and Advocacy Issues in Academic RadiologyEconomics Committee on Future Trends Economics Committee on General, Small, Emergency, and RuralEconomics Committee on HOPPS/APC Economics Committee on Interventional & CardiologyEconomics Committee on MACRAEconomics Committee on Managed CareEconomics Committee on Medical PhysicsEconomics Committee on NeuroradiologyEconomics Committee on Nuclear Medicine Economics Committee on Pediatric Radiology Economics Committee on Radiation OncologyEconomics Committee on ReimbursementEconomics Committee on Ultrasound


Thank youTRSDr. I. Ray KirkChristy McDonaldRenita FonsecaAlicia KothmannDr. Zeke SilvaDr. Kurt SchoppeDr. Don SchwarzDr. Melissa Chenand others

ACR Economics DepartmentRynzelle SpraggsKatie KeysorAngela KimPam KassingMaria TranAnita McGlothlinLaura PattieDominick ParrisChristina BerryStephanie LeChristy BuranaamornKevin Grantand others


Documents

2017 James M. Moorefield Fellow in Economics & Health Policy€¦ · 2015-Present: Radiation Oncology Residency at UT Southwestern - ACR RFS Economics Advisory Group - 2017 Moorefield