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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 3
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 4
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
The American Healthcare System
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 4
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
The American Healthcare System
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 4
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
The American Healthcare System
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 4
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
The American Healthcare System
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 4
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 5
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 5
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 5
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 5
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 5
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
~18% of GDP
MACRA
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 6
MIPS APMOR
Extends CHIPRepeals SGR
Shifts FFS to P4P
Value-based payment for physicians, not hospitals
MACRA
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 7
MIPS APMOR
PQRS VBPM MU
= Cost
Extends CHIPRepeals SGR
Shifts FFS to P4P
MACRA
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 7
MIPS APMOR
PQRS VBPM MU
= Cost
Composite Score (2018): 50% 10% 15% 25%
Extends CHIPRepeals SGR
Shifts FFS to P4P
MACRA
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 8
MIPS APMOR
ACOs Shared RiskBundled Payments
Extends CHIPRepeals SGR
Shifts FFS to P4P
Economics & Health Policy Department
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 9
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
Economics & Health Policy Department
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 9
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
Economics & Health Policy Department
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 9
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
Economics & Health Policy Department
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 9
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 10
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 11
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
2017 James M. Moorefield Fellow in Economics & Health Policy Ryan T. Jones, M.D. 12