Balancing Productivity and Quality: Radiology’s Tightrope Act

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Bill PickartRadiologist efficiency has increased by leaps and bounds in the digital era, but reimbursement trends have kept steady the pressure to improve productivity further. A handful of emerging tools for the practice potentially could make already-productive physicians even more efficient, according to Bill Pickart, CEO of Integrated Medical Partners (IMP); Pickart says, however, that these tools will represent a cultural shift that will need to be managed skillfully for maximum effectiveness. “I’ve seen a number of products come to market, in the past year, that are all designed to improve efficiency,” he says,” and using them represents a true change in how workflow is managed for radiology groups.”

The key issue, Pickart says, is the complex relationship between productivity and quality. If productivity increases unchecked, at some point, quality will inevitably begin to suffer; by the same token, quality, when pursued without attention to efficiency, results in inconsistent work output by physicians. For that reason, Pickart advocates using solutions that “aren’t about working harder, but working smarter. We have to work smarter—without sacrificing quality or clinical excellence,” he says.

Emerging Tools

Pickart highlights three informatics tools for improving radiologists’ efficiency without sacrificing quality. The first is the unified worklist, which aggregates a group’s caseload, irrespective of radiologists’ geographic locations; Pickart stresses, however, that the unified worklist alone is not a silver bullet. “It is merely a component of a system—an approach to practicing radiology in a more efficient manner,” he says. “What reinforces efficiency is having the right tools in place to improve and measure performance.”

With that in mind, Pickart cites two emerging solutions. The first is the real-time efficiency-monitoring tool used at Quantum Imaging & Therapeutic Associates, Inc (Lewisberry, Pennsylvania), by Elizabeth Bergey, MD, CEO, and Wayne Davidson, CIO. The tool lets radiologists know, as they work, whether they are on track to meet customized productivity benchmarks.

“Measuring productivity in real time is an effective way to change physician behavior,” Pickart says. “Performance is measured to standards that the group decides on and that can be changed over time, and analytics use is embedded in the process, so that it does not decrease productivity or efficiency. The logic of how these tools are used is critical.”

Another solution that recently emerged intelligently selects relevant background information from the electronic medical record (EMR) to help radiologists improve the quality of their reports without having to search manually for the data. “As EMR integration into the radiology suite of tools becomes more prevalent, the radiologist is burdened by the requirement to process more information,” Pickart says. “At some point, the radiologist’s ability to process all of the data will hit saturation. New tools query the EMR (according to protocols designed by the radiology group) and find the specific prior studies and relevant history required to enhance the quality of the interpretation—and do so in a very efficient manner.”

Cultural Considerations

Pickart notes that the topic of efficiency in radiology is emotionally charged because of its connection, or potential connection, to payment. “The largest single cost, for many hospital-based radiology groups, is compensation,” he says. “Given the declines in reimbursement that we are operating under, as well as the emergence of new payment mechanisms, compensation cost must be addressed, despite the emotional nature of the subject.”

For that reason, he says, a champion among a practice’s clinical leaders is necessary, both to enforce cultural change and to maintain quality as a priority. “Getting a single worklist in place has been the holy grail for many groups that serve multiple hospitals and health systems. While that’s important, it (with the implementation of other tools) needs to be promoted by a clinical leader,” Pickart says.

The role of that leader is not just to encourage the use of analytics to improve performance, but to look at the findings of analytics to understand whether the practice is on the right track. “The champion has to be supported by actionable information that allows him or her to guide the process, and its corresponding quality effects, as these efficiency tools are put in place,” Pickart says. “Every tweak