The Near Future Comes into Clear(er) Focus

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There is big power in big data. Moving forward into 2015 and beyond, how do radiology practices aggregate data in a way that creates what the world of Silicon Valley has shown us to be the new paradigm? Curtis Kauffman-Pickelle, president and CEO of The Kauffman Group and publisher of ImagingBiz, asks that very question when asked to look ahead.

“How can we mine data internally?” he adds. “How can we build up a more robust platform to be able to secure data in a way that tells us more about not only our practice, but also about the healthcare system in general? Predicting patient behaviors and outcomes is where analytics is heading. That means an evolution toward marrying patient activity and physician care recommendations with outcomes data—and comparing them to payer expectation benchmarks. 

“We don’t need more data,” explains Kauffman-Pickelle. “We need more insight on what the data can tell us to improve patient care and healthcare value.”

Kauffman-Pickelle also points out that patients are being asked to pay a larger share of their own healthcare bills, which is making them behave more like shoppers than sheep. Nor is price their only consideration. He notes that, during the height of the Ebola scare, a newspaper report came out in California showing patients and their families comparing infection rates among hospitals in the area.

“Radiology has been at the forefront of data acquisition and data mining,” he says. “It’s been a very early adopter in this schematic. So the ability of radiology to help drive the model toward the utilization of big data for analytics and informatics, I think is going to be one of the things that will continue to position radiology at the forefront of medicine.”

Kauffman-Pickelle agrees that innovative tools like vRad’s Radiology Patient Care indices—which allow hospitals, health systems and radiology departments to use normalized data to compare their utilization of CT imaging with that of similar organizations across the U.S.—are paving the way to better measuring, benchmarking and proving overall healthcare value.

Predictions on surprises no one sees coming? “The only surprising thing to me is that there are still radiologists who, for whatever reason, remain more worried about their individual comfort then they are about making the investment necessary to stay ahead of the curve on these big changes,” says Kauffman-Pickelle. “It’s incumbent upon radiologists to really, truly understand that they can be agents for change, but it will mean that they might have to move outside their comfort zone.”

A constructive ‘changing of the guard’ on Capitol Hill?

Fresh off the victory of having its three legislative priorities inserted into the sustainable growth rate (SGR) “patch” bill in 2014, the American College of Radiology is feeling upbeat about radiology’s prospects for 2015.

That’s according to Cynthia Moran, ACR’s executive vice president of government relations, economics and health policy. She expects major efforts from the government to get more savings out of fee-for-service Medicare, along with intensified discussion on moving toward site-neutral payment systems.

“I think we’re going to see a legislative desire to flatten the disparities between reimbursement in the hospitals verses in the office setting,” says Moran. “We don’t want a policy that devastates one at the expense of the other. We may have to deal with that situation very aggressively. We know that there is a lot of interest from the congressional perspective, because there is a lot of money to be saved if they start flattening those payments. And they could take those savings and help pay for the SGR fix, or they could attribute those savings to a number of other initiatives.”

And, of course, all eyes will be on Washington as the GOP takes control of both chambers of Congress for the first time since 2007.

“The threat of going to site-neutral was probably going to be there, regardless,” says Moran. Now it’s even more likely that the issue will be moved “even higher up the to-do list. So that’s probably going to be something that we’ll have to focus on.”

Speaker of the House John Boehner and incoming Senate majority leader Mitch McConnell are sure to try to make good on their day-after-the-midterms vow to repeal the Affordable Care Act and replace it with, in Boehner’s words, “commonsense reforms.” Boehner singled out for special attention the ACA’s Independent Payment Advisory board, individual mandate and medical device tax.

What will be the college’s position if the repeal-and-replace movement forges ahead?

“I think we are a long way from deciding how we would play that. We would have to see what the proposed replacement would look like,” she replies. “But these are going to be interesting battles to watch. The pressure is going to be on the Republicans to perform—to show that they can lead and they can legislate and they can run this branch of the government.”

“I’m excited regardless of my personal politics,” adds Moran. “I think a changing of the guard running the Senate is going to be healthy. If we were to maintain the status quo with divided houses of Congress, it’s hard to imagine that many things would break loose through the stalemate. So just for those of us who play in this game, action is more interesting. I just hope that the tire tracks are not down the middle of my face at the end of the period.”

Downstream challenges, upstream opportunities

The biggest single story developing in radiology—the one that dominates discussion now and looks to continue doing so for the foreseeable future—is the “perfect storm” created by the coming together of decreased payment for clinical services, a more challenging environment for external research funding and the need for all providers to document their every effort to improve quality. 

So says N. Reed Dunnick, MD, president of the Radiological Society of North America and chair of the Department of Radiology at the University of Michigan Health System.

“The other story is our national efforts to reduce the cost of healthcare, which affects everyone—payers, providers and patients,” says Dr. Dunnick. “Payers are struggling with ways to reward quality providers, yet reduce costs. Providers are looking for new ways of providing quality care that will be less expensive, and regulators are trying to find good measures of quality that are not merely process measures.”

Each of these has a “downstream effect,” he adds, noting that reducing costs means buying less imaging equipment and reducing the number of people needed to provide care, adding considerable stress to the staffers who remain.

The good news is, radiology is inherently part of the solution. “Twenty years ago, when patients came in with belly pain, they would often have an exploratory laparotomy. Now that’s never done anymore. CT tells you what’s going on in the abdomen,” says Dr. Dunnick. “Imaging has already been a great contributor to reducing healthcare costs. Because every one of these cases where it’s minimally invasive surgery means you get patients out of the hospital faster and back to work faster. The healing process is just much easier and, so, less costly.”

Convincing payers to see that value is another issue altogether, and Dr. Dunnick points to various leadership institutes that have sprung up to develop radiologists’ skills as high-level influencers. 

Heading into 2015, “the big issues are, and will continue to be, cost reduction, care quality and patient safety,” concludes Dr. Dunnick. “And there are the IT systems that, I think, are going to continue maturing and improving, one of which is decision-support software. I think that’s going to be good, as long as it allows for local modifications. I am sure the electronic health record will improve while other IT tools will come along that will help us all do a better job more efficiently.”

Doing a better job more efficiently: In that simple concept lies the future of radiology—and of healthcare as a whole.