The Quality Challenge

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Defining quality in radiology seems simple: It’s an accurate diagnosis or interpretation, provided in a timely manner, in a clear and easy-to-follow report. The devil is always in the details, though.

How do you measure accuracy? Are you consistently measuring your patient’s or referring physician’s experience? What’s a good baseline? How are payors defining quality, and more important, how will they structure reimbursement plans around it? What resources will the practice have to devote to measuring quality and the revised processes that come out of it? How do you determine the return on investment in quality?

Our practice is one of the many radiology practices facing these challenges. Charlotte Radiology, PA, is a private radiology practice in Charlotte, North Carolina, comprising more than 80 physicians. We, like many radiology practices, recognized the importance of quality long ago, but are now taking the necessary steps to define, measure, and communicate quality to our key audiences. Arl Van Moore Jr, MD, president of Charlotte Radiology, says, “We have always felt that we provided a valuable, high-quality service. Now, we have to prove it.”

Charlotte Radiology started its quality initiative 10 years ago, by creating a quality committee that broke down the topic into several critical areas; it is working to set benchmarks and strategies for measuring our future success. The quality committee is composed of a few key staff members and radiologists representing different imaging modalities. The committee’s job is to ensure that all areas affecting quality outcomes are addressed.

Linda Cox, director of quality improvement and risk management for Charlotte Radiology, has been with the practice for 13 years and has worked in quality management for almost 20 years. She says, “Anyone hoping for an easy solution is in for a surprise. The more we looked at how quality is affected by various parts of our practice, the more we realized it’s a part of everyone’s job. We are working with all departments, in one way or another, as that relates to quality. Once we have thoroughly outlined how we are addressing, reporting, and measuring quality, we’ll develop a communication strategy to share our benchmarks and successes with our key customers.”

Assessing Clinical Quality

Charlotte Radiology’s physicians have a strong commitment to ensuring the accuracy of their interpretations. They embraced subspecialty radiology early on, allowing for a more focused approach to care. In addition, our technologists are certified in their imaging modalities. “Even with a great team, though, we know we aren’t immune to errors,” Cox says. “We have always looked at the accuracy of reports and analyzed where we can improve, but today, we have multiple tools at our fingertips to help us measure our success and benchmark ourselves against others.”

One of those tools is the ACR® RADPEER™ program. ACR interpretation guidelines state that comparison with older studies should always be done when reading an examination. Use of the ACR RADPEER program allows comparative peer review to be done on the older examination with a current study. The results are sent to the ACR for benchmarking and comparison purposes. Charlotte Radiology has actively endorsed this peer-review program for more than three years.

“Currently, we use the data to look for areas and physicians needing improvement,” Cox says. “Sometimes, however, you find that what’s broken isn’t the physician, but rather, a process. RADPEER has helped us to identify several different departmental processes that needed revision, as well as to note an occasional system-hardware issue that needed adjustment.”

One process-improvement opportunity that the practice recognized was the need for the radiologist to identify situations readily in which timely communication of an unexpected (but not critical) finding could alter the patient’s surgical or medical management. We made patients’ histories more accessible to the radiologists while they are reading studies, and then we set up a process for notifying referring physicians, by phone, of unexpected findings. “Identifying such problems and developing appropriate solutions have helped improve the timeliness and efficiency of our radiologist workflow, thus improving service to clinicians and care rendered to patients,” Cox explains.

Charlotte Radiology quickly realized the benefits of RADPEER, but had to find a solution to support its