As health care faces diminishing reimbursement and the emergence of new payment models, radiology departments are increasingly tracking and reporting on a wide array of analytics, ranging from quality to utilization. "We are absolutely under increasing pressure to provide this information to the organization as a whole," says Vijay Rao, MD, professor and chair of the department of radiology at Thomas Jefferson University, Philadelphia, Pennsylvania. "There are a number of analytics we monitor fairly rigorously, and there will always be new things that come up that you have to measure and understand."
"Something that is always pointed out is that inpatients wait a long time to access high-end imaging modalities, and the impact of that on length of stay is a very important issue for hospitals."
—Vijay Rao, MD, Thomas Jefferson University, Philadelphia, PA
These analytics, Rao says, include both data for departmental use and data reported to the larger organization, and are part of larger initiatives to improve the appropriateness and quality of radiology while maintaining physician productivity and patient access. "There's a lot of pressure related to productivity. It's a huge issue," she says. "Institutions want to make sure that people who are highly productive are being compensated at the appropriate level." Managing this maze of stakeholder needs and expectations is simplified, she says, by IT that helps the department track a wide variety of metrics.
As department chair, Rao receives one report on a regular basis that measures procedures by modality and location, "to see how our practice is doing and to identify areas where we are growing, and where we want to grow," she says. Another report looks at turnaround time, not just in total, but segmented for added specificity.
"We look at time from study order to study completion, time from completion to time dictated, and time dictated to time signed and finalized," she says. "Because the bulk of our work is dictated by residents and fellows, we have to constantly ride herd to make sure people sign their reports. Now we are looking at putting some incentives or penalties in place to really drive people." Rao and team also monitor turnaround time just for emergency department exams, ensuring that they are completed according to timeframes decided on between the two departments.
Another department-level report is on work RVUs for faculty members, which Rao and colleagues benchmark against nationwide data by subspecialty area. The radiology department at Jefferson also has a robust peer review process built into its daily workflow that feeds information to the ACR RadPeer registry, and tracks the discrepancy rates between preliminary and final reads for residents. "We like to make sure we're within an acceptable range compared to faculty reads," Rao says.
Finally, the department has initiated a dose reduction project for CT. "The ACR registry for dose is not that robust yet, so for the time being, we are just doing our internal monitoring and collecting that data," Rao says. "But I think that database will become more robust in the future."
As Rao highlights, however, radiology departments also must increasingly report data to the organizations to which they belong, a paradigm that can be expected to intensify with the emergence of new payment models. "Length of stay has become a very critical issue for the hospital—they want to be sure it meets the national benchmarks, and of course, the lower the length of stay, the more admissions they can bring in," she says. "There will also be more pressure on utilization management, and under the ACO model, that pressure will be more intense because of bundled payments."
Analytics reported to the organization as a whole include five imaging-related Physician Quality Reporting System [PQRS] measures, such as carotid measurement of stenosis and reminder letters for mammograms. "All eligible faculty have to have 100% compliance with PQRS,” Rao notes. "We submit them to our faculty practice plan, and we don't get paid if we don't meet those criteria." Patient satisfaction scores, as measured through Press Ganey surveys, also are reported, as are measures related to the universal protocol, including hand-washing. "They measure a million things," Rao says.
Access for outpatients and wait times for inpatients