Next-generation Analytics for Radiology
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, PAThese 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. Departmental Concerns 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." Organizational Analytics 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 are measured and reported on as well, Rao says. To measure access for outpatients, the radiology department looks at its wait times for available appointments. "It needs to be within two or three days—if it gets to be more than that, we see if we need to run the scanners later, or on the weekend," she says. "Based on that data, we are currently running the outpatient scanners in our main center seven days a week. We run our MRI from 7 am until 10 pm every day." When wait times for inpatients exceed a certain threshold, the radiology department breaks down the delay based on a checklist. "Delays for inpatients are multifactorial—it could be anything from transport delays, to the patient wasn't stable enough to get the exam, to the patient couldn't tolerate the exam or was in too much pain," Rao says. "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." The radiology department also reports on productivity, and Rao expects to see increasing pressure to report on utilization. "There will absolutely be more pressure to report on utilization management in the future," she says. "Especially in academic centers, there are a lot of unindicated or inappropriate studies done, because often the ordering is done by health staff, who order imaging studies without their attending [physician] knowing." For this reason, Rao also anticipates reporting more data on dose management in the future—and believes the data the radiology department currently collates will help. "If we can build in a system that shows the clinician that the patient has already had four CTs in two months, and this is their cumulative dose, that could be a big help with controlling utilization," Rao says. "Small steps like that go a long way in making sure only appropriate studies are ordered. We as radiologists need to show some leadership in driving these changes—we need to do the right thing for patients." Cat Vasko is editor of HealthIT Executive Forum.