Imaging Appropriateness, Without Emotion: An RPC Index Case Study

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 - Ray Montecalvo, MD, Medical Director for Virtual Radiologic (vRad)

Ray Montecalvo, MD, medical director for Virtual Radiologic (vRad), describes the key benefit of radiology analytics simply: they take emotion out of the equation. “From my twenty-five years of experience in the industry, it’s the squeaky wheel that often gets the grease,” he says. “When a hospital’s physicians feel like they need something, the story gets repeated until it reaches the ears of hospital administration - even if there’s no business case to support the request. That’s how a lot of decisions were made in the past; in the future, decisions without analytics demonstrating credible cost, benefit and patient impact just won’t cut it.”

In today’s constrained health care environment in which radiology groups are being paid less for ever-increasing volumes of work, it’s imperative that practices have insight into their own data when entering into conversations with their hospital customers, Montecalvo says. “Groups are finally waking up and realizing that the status quo is no longer an option; radiology must innovate once again in response to the consolidation of healthcare and the shift away from fee-for-volume.” 

Case in point: while there is a lot of focus and debate on future clinical decision support (CDS) models and requirements for appropriate imaging, Montecalvo maintains that private radiology groups can use analytics today to provide immediate value to their referring physicians and hospital administrators.  “There’s no margin of error anymore,” he observes, “The time to start becoming an indispensable partner can’t happen soon enough.”

Improving Service

In one example of how radiology analytics can create a fact-driven platform for productive conversations between physicians and hospital administration, a hospital client of vRad’s came seeking help with a request from a group of their referring physicians to add an additional full-time CAQ [Certificate of Added Qualification]Interventional Radiologist.  Montecalvo explains, “This particular hospital system has a big Medicaid population and is reliant on the state for some of its funding, but it also has a very successful oncology center.”   As a result, he says, any request coming from the oncologists is taken very seriously by the administration.

“The oncologists were requesting more access to higher-end interventional radiology work,” Montecalvo says, “and of course the CEO wants to keep them happy.”  Radiology modalities were reviewed and compared against vRad’s RPC Indices, the first findings-based national benchmarking metrics leveraging vRad’s clinical data warehouse of over 25 million studies.  Montecalvo explains, “This was the first time the hospital was able to see ‘inside their data’ and across their facilities, including functional IR volumes, patient-to-procedure ratios, referring physician findings and other quality performance metrics that had been unavailable because the hospital had no way to convert billing data into actionable insight, let alone normalize and benchmark their performance against peer groups.”

The referring physicians’ sense that a CAQ IR was needed was just that—a feeling not substantiated by the analytics.  “When we dove into the numbers, we saw there wasn’t nearly enough volume and RVU value to support a CAQ Interventionalist, in spite of what the oncologists believed,” explained Dr. Montecalvo.”  Instead, the analytics showed what the hospital could and should support: an additional mammographer.  “During the analysis, we identified that women’s imaging at the hospital was only at 50% of the national average for their peer group,” Montecalvo continued.  “This was an unexpected outcome given their patient and market demographics; they had the female population base to support a much higher level of mammogram activity.”

Armed with that information, the client’s radiologists were able to seek out a very specific type of colleague: one who could support the growth area of women’s imaging, while providing additional IR support as required.  “Our client physicians had the analytics and insight to have an unemotional, fact-based discussion,” explained Montecalvo.  “We were able to find the person who could really help them, as opposed to the person they thought they needed.”  That type of value add, according to Montecalvo, is what separates radiology groups into clinical vendors vs.  long-term patient care partners.

Improving Quality – with a Retrospective Look

But analytics are valuable for much more than improving

Cat Vasko is a contributing writing for Medical Imaging Review