Imaging and the ACO: Collaborating on Patient-centered Care

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Michael Budimir, regional director of imaging services for Franciscan Alliance, an Indiana accountable-care organization (ACO), defines the principal goal of the ACO simply. “Everything has to be patient centered,” he says. “Today, in health care, we have to reevaluate everything from the patient’s perspective. In the ACO model, what helps the patient also helps the institution.” Budimir, who oversees imaging at the health system’s four northern Indiana hospitals, says that Franciscan Alliance’s path to achieving this goal is based on partnering with physicians—both those it employs and those with whom it is affiliated, such as its radiologists. “We were searching for the best way to partner with our physicians to collaborate in providing high-quality care to our patients in a cost-effective manner,” he says. “In looking at the way health care is headed, we thought this was a component of the ACO model that would benefit us.”

Role of the Radiologist While some ACOs have turned to large-scale employment as a means of encouraging collaboration among their physicians, Franciscan Alliance has maintained the contracts that it had with its radiology groups prior to making the transition to the new payment model. “We look at the radiologists as having a key role to play in the care of our patients,” Budimir says. “They have as much of a stake in the success of our institutions as the referring physicians have (or any other service line has). They have become even more participative and collaborative: That’s what is required, in this environment, for everyone’s benefit.” Franciscan Alliance’s radiologists are embracing these roles, discussing the appropriateness of ordered studies with referring physicians and helping to direct patients’ care. “We are seeing a lower volume of imaging studies being ordered now, and what is being ordered is more appropriate,” Budimir says. “Physicians are making better-informed decisions about what needs to be ordered, and they’re looking to the radiologists either to substantiate those choices or to advise them as to whether they’re using the right modality for the right exam for the right proper diagnosis.” Should an inappropriate study be ordered, radiologists bring the issue to the attention of the ordering physician, and inform him or her as to the proper method of testing required. “We want to provide what’s best for the patient,” Budimir says. “We’re all engaged in being the best possible advocates for our patients, and coordinating their care is paramount.” Evolving Technology Needs As its radiologists’ roles evolve to become more patient focused, so do the organization’s imaging-technology needs, Budimir says. “We’re looking at the technology more in terms of where the market is going than ever before: Can the equipment be multipurposed to optimize its use and maintain efficiency? We have to consider whether the patient is going to be comfortable and whether this will help ease his or her anxiety. Additionally, we have to consider how the equipment is serviced and its dependability. That’s also in the best interest of the patient,” he notes. As an example, Budimir points to the organization’s implementation of two Oasis boreless 1.2T MRI systems from Hitachi Medical Systems America in 2012. “This piece of equipment has really helped us create a closer working relationship with our patients,” he says. “The Oasis systems have addressed, on numerous occasions, the issues of patients feeling confined or claustrophobic in traditional, closed-bore MRI systems. MRI is one of the most dreaded imaging exams. With the Oasis and its open bore, the patient doesn’t feel enclosed: It reduces patient anxiety as it relates to claustrophobia.” He adds that imaging technology, in general, is evolving to meet patients’ needs better. “Tables for radiography, CT, and MRI are getting bigger, to be able to handle much larger patient sizes: We have a growing society, and we need to address that issue,” Budimir observes. “Our society also experiences a lot of claustrophobia with CT and MRI. We have to consider how our patients are treated, and that is something that is increasingly important.” Going forward, Budimir expects to see Franciscan Alliance’s radiologists continue to deepen their collaboration with other physicians and service lines, and he believes that imaging technology will play a critical role in supporting that evolution. “Medical teams will come together to coordinate patient care, bringing