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December 11, 2013
Beyond Interpretation: How Radiologists Can Survive in a Value-Based Care Model
By Rajiv Leventhal
At last month’s Radiological Society of North America (RSNA) conference, Mary C. Mahoney, M.D., chair of RSNA’s Patient-Centered Radiology Steering Committee, said that radiologists must be portrayed “as knowledgeable physicians—the imaging experts—and show that we’re patient advocates by demonstrating concern and knowledge about safety and risks. Many patients don’t even know we exist. We can’t just be a name on a bill.”
Optimizing the entire patient experience means that radiologists need to go beyond image interpretation and get involved before and after exams. This is the idea behind Imaging 3.0, a call to action—led by the 36,000 members of the American College of Radiology (ACR)—to all radiologists to take a leadership role in shaping America’s future healthcare system.
Additionally at RSNA, Bibb Allen Jr., M.D., vice-chair of the ACR Board of Chancellors said in a presentation, “It goes beyond interpretations. It’s about assuring appropriateness, documenting the quality and safety radiologists provide, actionable reporting with evidence-based follow-up, and empowered patients. We would have a measurable role for radiologists in improving population health and we would have a calculation of radiology’s value in reducing per capita cost.”
One organization that has begun to make strides in this area is the north central Ind.-based Radiology, Inc., a 109-year old independent radiology group. Samir Patel, M.D., leads the team of 28 radiologists, and stresses the importance of current and next-generation radiologists building out their skills sets beyond report interpretation in order to survive in a value-based care model.
Last year, Radiology, Inc, which services Elkhart General Hospital in Indiana, two other hospitals in the state, and several outpatient centers, began to implement a value-added matrix, which is a copyrighted document that identifies 36 categories of value that have nothing to do with film interpretation, says Patel. “All of the radiologists have scorecards, and any time someone performs a value-added activity, they fill out a piece of paper and send it to the central billing office, which then gets tabulated into a database,” says Patel. “So we can quantify all the different value-added activities that we do such as hours spent on conferences, on committees, transcription time, teaching, and research.”
At Elkhart General last year, the team of radiologists documented 3,000 hours of value-added services to the hospital. In 2013, the organization has taken this to the other hospitals it covers, and through the first 10 months of the year, has documented more than 6,000 hours of value-added services within the group. “We presented this to administration. The value management program, to sum up, is invested, aligned, citizenship actions optimizing value-added patient-centered outcomes,” says Patel. “The idea is basically to quantify, document, and present all the non-interpretation services we do, and present to our customers—the hospitals—what we’re doing.”
Patel says he recently presented this information to leaders at the Beacon Health System (an affiliation of Elkhart General and the South Bend-based Memorial Hospital), and they are now beginning to see the true value of the services radiologists provide. Radiology is unique in that many other specialties are behind it in terms of being able to measure its services, Patel says. “No other specialty is providing this quantification of all of the other [things] that we have to do. This is something that I have not seen anywhere else.
“Other specialties need to not only perform, but document, quantify, and present everything they do to their customers, who will primarily be hospital administrators and referring physicians,” Patel continues. “Here, many of those referring physicians have seen tremendous value in these services, and have a better appreciation of it. We don’t come in, read films and go home. This sheds light on that—rather than me just saying what we do, we can now quantify it. Health systems that have been presented with this now have a better understanding [about radiologists], which is important because most physicians think all we do is read films.”
What is key, of course, is for Radiology, Inc. to not only show hospitals what services the radiologists are providing, but demonstrate what the customer is getting out of it. “Last year, we provided the hospital the outputs, or outcomes, which were 105 key performance indicators on what it received from our services. An example of this was turnaround time metrics that we monitored to them, as well as 20 national imaging accreditations and designations that partly came from our work,” says Patel.
Additional value included more than 4,000 critical test results reported, more than 5,000 imaging studies that were peer reviewed, 164 hours of teaching, and elimination of more than 400 hours of transcriptionists’ time, according to Patel. “The 3,000 total hours were on the input side, while these were things on the output side,” he says.
Moving forward, Patel sees increased pressures on radiologists as the industry moves to a value-based care model. “Not only will we see radiologists having to interpret images at a very high level, but they will also have to document and perform all these other activities. I don’t think this will be an option, but a requisite for survival,” he says.
However, if these services are performed, quantified, and documented, then the outcomes will be improved, Patel says. “The ultimate judges are our administration and our referring providers,” he says. “[Elkhart General] just recently did an internal survey of physicians, and the radiology department scored the highest in terms of quality service and accuracy of interpretation. That told us we were on the right path.”
Disproving the many misconceptions about imaging is also important to the future of radiology, Patel feels. According to him, people think there is an overutilization if imaging in certain aspects, as well the perception that radiologists recommend too many studies, and the idea that anyone can read a film.
Further, Patel says, there is a misconception that medical imaging is the only reason for high health costs and is a major reason for spiraling health costs. “These are myths without support,” he says. “It is significant for radiologists to educate everyone on the outside on what exactly the field is and all of the benefits we provide. Radiologists need to be engaged at all levels.”