ACOs and the Radiology Practice: Adding and Quantifying Value
The stated aims of accountable-care organizations (ACOs) mirror the triple aim proposed by the Institute for Healthcare Improvement (Cambridge, Massachusetts), and both sets of goals have one common thrust: placing the patient at the center of the health-care continuum. As Linda Skarzynski, CFO for Triad Radiology Associates (Winston-Salem, North Carolina) notes, many radiology practices are well positioned to help. “Whether it’s now or in the future, patient safety is always the top priority,” she says. “Any systems we can put in place to serve that goal better are what we want to pursue. In an ideal world, a radiology practice’s priorities would be the same, irrespective of its participation in ACOs.” Skarzynski’s words emphasize what many in the radiology community have sought to underscore since CMS announced its ACO program: Radiologists can be stewards of smarter, safer, and more effective patient care. Rick Blake, chief business-development officer for independent physician group Cornerstone Health Care (High Point, North Carolina), concurs. “Radiologists have an important role to play,” he says. “They have specialized training in both diagnosing and treating patients. That’s the skill set they bring to the equation, but they have to demonstrate that their skills translate into better care.” Data Imperative To demonstrate that their ACO participation enhances the quality and safety of patient care, radiology practices will need to be able to track a variety of measures, Skarzynski says. Placing data about utilization and outcomes side-by-side will make possible a deeper understanding of whether an imaging procedure positively affected care, but many practices are not equipped to receive outcomes data from larger health systems—just as many health systems are not equipped to share those data securely. “Unless you can have access to information across medical systems, you’re not going to have the absolute answer,” she says. “If systems could be developed to accomplish some type of efficient utilization tracking that would both ensure patient safety/quality and make sure the integrity and value of the radiologist contribution could be maintained, that would absolutely be a positive step for practices.” Blake suggests that health information exchanges (HIEs) might be leveraged to reach this goal. “It’s through the electronic medical record that we can achieve a lot of these objectives, if we use the HIE,” he says. “The beauty of all this is that it does embrace that everyone adds value to the patient-care experience—we just have to do it efficiently. The key word, though, is evidence. We need objective data to change the cost and quality curves, finally.” A potential source of those data, Skarzynski says, might be traditional financial indicators such as work RVUs—if they can be used to demonstrate the impact that ACO participation has had on radiology practices’ management of patients. “If you could track pre-ACO and post-ACO utilization, that would be ideal,” she says. “Then, we would have a very good basis for saying how much we decreased utilization and for quantifying the value of that.” Blake agrees; he says, “I’m confident that radiologists can demonstrate that value; then, they too would be part of the shared savings.” Quantifying the Intangible Finding new ways to aggregate and share data is one challenge; quantifying new requirements, such as increased interaction between radiologists and their constituents, is another. In order truly to change the utilization paradigm, Blake says, “The radiologist needs to be consulted, so he or she can say the patient doesn’t really need that expensive CT scan—or, in contrast, should proceed directly to that CT scan because it is the most conclusive method of diagnosis.” There’s little question that radiologists will need to become more active members of the care continuum in the ACO model, but balancing this requirement against considerations such as turnaround time and efficiency will be a challenge, Skarzynski says. “If the radiology group becomes an integral part of the ACO, radiologists will be pulled in new directions,” she explains. “Maintaining their productivity and turnaround times (while also carving out time for patients and referring physicians) creates time demands that have to be resolved.” The solution might be an informatics platform that makes fast, efficient communication between clinicians possible, enabling the radiologist to maintain workflow while being accessible for consultation. “If there were good systems in place where a radiologist and a referring physician could share information in a timely manner, it would be better than computerized decision support,” Skarzynski says. The question, then, becomes how to compensate radiologists as they transition away from the fee-for-service model—and for now, the answer remains to be seen. “What is the value to the radiology practice? Is it something along the old capitated lines of a fee per member, per month, or is it based more on how many patient encounters the radiologists had and how many times they spoke directly to the referring physicians?” Skarzynski asks. “It can’t just be the value of what the studies would have cost the ACO. Other aspects have to be considered as well.” Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.