Here are my slides from the Tuesday RSNA 2019 session on reimbursement. If you would like the PPT version please contact me directly.

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

5. FAIR REIMBURSEMENT

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

15. Allergy
Testing
Diaphragmatic
Hernia Repair
Radiology
RELATIVE VALUE UNITS
15

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

19. PRIVATE PAYORS
19

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

31. QUALITY & SAFETY
STANDARDS

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

37. PATHWAY TOWARD
REIMBURSEMENT

38. SUMMARY
ISOLOATION
FEDERATION
TINKER
THINKER
HOBBYIST
LOBBYIST

39. FRANK.RYBICKI@UC.EDU
@FRANKRYBICKI