Emerging Practice Models in Radiology: Patient-centered Imaging
This article is the first in a four-part series on emerging practice models for radiology. The theme of 2012’s annual RSNA meeting in Chicago, Illinois, was Patients First, reflecting a question on the minds of many in the imaging community: How can a specialty with very little patient interaction built into its workflow improve its service to patients? As an emerging practice model, patient-centered radiology has a nice ring to it, but as Greg Thomson, CPA, executive vice president with Medical Management Professionals (MMP), notes, “This represents a major cultural leap for radiology. Radiologists have long had multiple customers—including referring physicians and hospitals—along with patients, and because they often do not interact with patients, their focus has been on the referring physicians, not the patients. It is a mindset shift for the specialty.” Currently, Thomson says, many radiology groups, be they operators of imaging centers or hospital-based groups, are in the measurement phase of assessing how to improve patient care and satisfaction. “Radiology groups are beginning to test benchmarks, agreeing to increase their patient-satisfaction scores by a certain percentage,” he says. “It is a conversational shift: Instead of talking about what makes patients happier in the abstract, groups are looking at the specific steps they need to enact.” Imaging Centers Thomson breaks down the trends that he sees occurring in patient-centered radiology by environment. Imaging centers, he notes, have a little bit more freedom than hospital-based radiology groups, when it comes to making an impact on patient satisfaction. “Radiologists who own imaging centers have been thinking along these lines for years,” he says. “Communication with the patient and patient satisfaction are first and foremost for them, because they want patients to keep coming back to their imaging centers.” For instance, more and more imaging centers are offering screening-mammography results before patients leave the facility. He says, “It is becoming more and more common, and in terms of patient satisfaction, it is a service that is very well received by patients.” Still, the patient-satisfaction equation continues to evolve in the outpatient arena, Thomson notes. One emerging trend is offering on-site customer-satisfaction surveys for patients, which are completed using tablets handed out at the registration desk. “This is a far superior approach than sending patients paper surveys by mail—good luck getting those back,” Thomson says. “This trend reflects the fact that radiology is in an information-gathering period. Patient satisfaction is focused on much more than it has ever been in the past.” Another new development is the use of third-party companies to assess how patients are rating imaging centers online, both on review sites such as Yelp.com and on social-media platforms. “Many of these companies got their start in the hotel industry,” Thomson notes. “They look for information on the Web and pull it down whenever their client’s name is mentioned, and then they rate the mention as positive, negative, or neutral.” This kind of analysis is slowly gaining ground in radiology (and other areas of health care) as younger patients take to the Web with their impressions. “Members of the younger demographic are very apt to report back on their experiences online, and these companies are there to give practices an overall report on what their patients are saying about them. That is something we can expect to see more of, going forward,” Thomson says. Hospital-based Groups In the hospital environment, by contrast, groups have to take a more collaborative approach to gathering and responding to patient-satisfaction data. For this reason, Thomson says, co-management agreements between the hospital and the radiology group have become increasingly popular as a means of formalizing expectations. “Radiology groups have always worked hand-in-hand with hospitals to improve continuously the operations of the department,” he says, “but what has been happening in the last year or so is that both the physicians and the hospital administrators have found it is helpful to document what that should look like.” Often, Thomson says, cost-cutting measures are included in these agreements. “Hospitals are becoming increasingly focused on things like the cost of imaging equipment or related supplies, such as contrast agents,” he says. “What that has to do with patient satisfaction is that it is all about decreasing the financial burden put on the patient. By working together to reduce the cost of providing services, both the hospital and the radiology practice can provide the best price to patients.” Hospitals are also doubling down on patient-survey information—and asking the radiology groups with which they contract do the same. “Hospitals and radiologists are putting benchmarks into these co-management agreements, saying here are the scores; let us work together to increase satisfaction by 5% over the next year,” Thomson explains. “The hospitals are interested in sharing the financial benefits that come from improving these benchmarks.” Thomson points to a recent OIG Advisory Opinion1 outlining how a hospital can make performance-based payments to a cardiology group (for achieving quality and cost-savings benchmarks in connection with the operation of cardiac-catheterization laboratories) without running afoul of the anti-kickback statutes or incurring civil monetary penalties: He says, “There are guidelines now that hospitals and groups can follow.” Looking Ahead Thomson observes that the emphasis on improving patient satisfaction, be it in the increasingly competitive outpatient sphere or the ever-more-scrutinized hospital sphere, will only continue. “Radiology is so competitive and so portable,” he notes. “The competition is much fiercer now, and that requires a mindset change: Radiologists need to give evidence of their quality, and not just on a technical level. They need to provide evidence of their service to patients and referring physicians.” That means measurement, measurement, and more measurement, according to Thomson. “We can expect the information gathering around patient satisfaction to intensify,” he says. “Having the information to make the appropriate changes to radiology practices is absolutely vital to survival, and today’s technology is allowing that to occur differently—and more effectively—than it has in the past.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.