As radiology groups continue to contemplate the transition from fee-for-service to value-based medicine, the question of what constitutes value is central to their plans for the future—and unearthing the answer begins with understanding the needs of hospitals and health systems in evolution, according to Geraldine McGinty, MD, MBA, chair of the ACR® Commission on Economics. “Most hospitals are still functioning on a fee-for-service basis, but they are clear on the imperative to change to value-based care,” she observes. “Demonstrating your value to your hospital system—especially with the consolidation that has been happening in many markets—happens on several levels.”
Provision and demonstration of value is the central focus of the ACR’s Imaging 3.0 initiative, the goal of which is to give groups “the tool kit necessary to make the transition from volume to value,” McGinty says. Many of the tools are related to IT and to the ability to generate meaningful data.
“Practices will need to be able to demonstrate, among other things, what the amount spent on imaging would be for their hospitals, so that when they talk about maintaining quality while reducing costs, everyone understands what that means to the hospital’s bottom line,” McGinty says. “For hospitals embarking on the volume-to-value transition, other metrics will be critical as well.”
Measuring and Proving Value
Many of these measurements necessitate the use of data from multiple facilities, nationwide, to establish meaningful benchmarks that hospitals and health systems can trust. “To be valued by the health system, one thing to demonstrate is that you can help reduce readmissions—since there are now penalties associated with readmission rates,” McGinty advises practices.
She adds, “Decreasing length of stay is also very important. Groups should be working with the emergency department to understand where early appropriate imaging can reduce time in the emergency department and decrease admissions, and radiologists should be represented on every committee in the hospital as well. You may need to knock on the door a few times to make sure you’re truly involved.”
The patient experience has also become a key indicator to measure, thanks to the linkage of Hospital Consumer Assessment of Healthcare Providers and Systems (or HCAHPS) scores to reimbursement. “Hospitals know there are multiple moving parts when you’re trying to keep patients happy,” McGinty says. “For radiologists, contributing to increased patient satisfaction can be an important way to demonstrate value.”
This can be tricky for groups to conceptualize, as radiologists have been comparatively isolated from patients. McGinty advises them to start by putting themselves in the patients’ shoes. “Imagine what you would want for yourself or for a family member,” she says. “Think about the patient’s experience of your department, from start to finish, including being greeted and registered. How can you create a better experience for your patients at each step?”
It’s not surprising that one of the areas most ripe for improvement is communication. “Patients want to talk to us to understand their reports fully,” McGinty says. “We have to find a way to get them the information they need in a way that means something to them and helps, rather than hinders, the relationship patients have with their other physicians.”
An area of unique opportunity for radiologists is radiation safety/dose. This can be challenging to communicate effectively. “We would never want patients to avoid an imaging exam that is clinically beneficial because of a radiation concern,” she says. “The most important thing to convey is that we are making sure they’re getting as little radiation as possible to make the diagnosis (and have a positive impact on their care).”
Creating a mechanism through which patients can get in touch with their radiologists to ask questions can go a long way toward enhancing patient satisfaction. “I’ve actually always put my cellphone number on my business cards, and I’ve never had a patient call me inappropriately. Patients have always been respectful of my time,” McGinty says.
“Even if you don’t go that far, however, it’s incredibly reassuring for patients to know they have a way to get in touch with you (or a designated patient representative in the radiology department). We need to make communication really easy. It’s what we would want for ourselves,” she adds.
To show true added value, however, groups will have to demonstrate more than improvements in their own quality and efficiency. They will also have to show health systems how their contributions can lead to continuous improvement throughout the care continuum. “Imaging’s armamentarium is becoming so complex that the ability to tailor the study to the exact clinical problem is not something we should expect from referring providers,” McGinty explains. “Our role should be to guide them through that.”
By making full use of evidence- and consensus-based data to provide decision support that fits into referring clinicians’ workflows, radiology groups can actively drive appropriate imaging throughout their health systems. “We need to make our guidance available to them in a way that works for them and ensures they are comfortable consulting us. It needs to be a real collaboration,” McGinty says. “In the future, we will be likely to see the emergence of more midlevel providers making imaging decisions, and they, especially, will need our guidance.”
Certain health systems, around the country, have been ahead of the curve on initiatives such as this, with promising results. “At Massachusetts General Hospital (Boston), where they’ve been using clinical decision support for several years, the radiology group can show the health system reductions in inappropriate use of advanced imaging—and that it has helped providers learn more about what imaging is appropriate,” McGinty says.
She continues, “When you can see where you have been successful or unsuccessful in improving appropriateness, you have the opportunity to identify providers whose ordering patterns do not conform to guidelines (more often than the patterns of their peers). If you can do something to help educate them for the future, that’s very valuable.”