Value-added Radiology, Defined

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If on-site radiologists want to distinguish themselves from other image-reading specialists or teleradiologists, they must be more than image readers, according to Vijay Rao, MD, David C. Levin professor and radiology chair at Jefferson University Hospitals (Philadelphia, Pennsylvania). On December 1, 2011, she presented “Value-added Services of Hospital-based Radiology Groups” in Chicago, Illinois, at the annual meeting of the RSNA. Rao outlines the reasons that might tempt a hospital to replace an on-site radiology group with a teleradiology group and then counters them with a list of on-site radiology’s value-added services. “Hospitals may be attracted to a teleradiology company or tempted to give away privileges because they didn’t really understand the value that we have— or we haven’t educated them enough,” Rao says. “Sometimes, maybe we aren’t adding the value we should be adding.” Perhaps the group does not provide the subspecialty expertise that clinicians are asking for, or maybe the service level is poor in the areas of turnaround times and willingness to sit on hospital committees. “It is possible that the radiologists own an imaging center that competes with the hospital,” Rao says. The hospital might wish to give turf to specialties that make image interpretation a condition for referring patients to the hospital (economic credentialing); might desire more control over physicians in support of quality and cost-containment initiatives; and might want a share of the radiology professional component. “The hospital may want to bill globally (and have the radiologist on a salary) so it can benefit from the professional component,” Rao suggests. Not only must hospital-based radiologists deliver the entire continuum of services to the institution, but they also must market their value-added services to the administration. Rao divides radiology’s value-added services into six categories. Patient safety: Imaging patients face potential risks from exposure to radiation, magnetic fields, and contrast media. Vigilance by well-trained physicians is needed to minimize those risks, Rao says, and radiologists are the only physicians who get formal training in radiation biology, radiation safety, and how to treat contrast reactions. Radiologists are on-site in the department and available to deal with these issues when problems arise. Exam quality: Quality is increasingly important in this era of pay for performance. Rao has been a strong proponent of an overarching quality/ safety committee that would oversee all interventional procedures. Radiologists receive formal training in the physics and technical aspects of imaging equipment and also are able to ensure that the patient gets the right exam done. “Urologists at your institution may have privileges for CT, but they are not in the best position to determine whether MRI would be the more appropriate exam because they only look at stones,” she says. “They are not trained in MRI. We know all of the modalities and can advise” referrers and patients. Other important image-quality services provided by radiologists include optimizing imaging protocols, supervising and providing education for technologists, and overseeing the process of gaining and maintaining accreditation. “Do you think other physicians or teleradiologists can do this?” Rao asks. “Only on-site radiologists do this.” Interpretation quality: In training, radiologists spend a minimum of five years exclusively studying imaging, and they are commonly urged by professors to find the four corners of the image. “We can interpret the entire image, not just one organ,” Rao says. “The problem with cardiologists who want to do cardiac CT, for example, is that they may miss lesions in the lung, potentially the cause of the patient’s symptoms.” Arriving at a diagnosis might entail integrating images from all modalities— something at which radiologists are adept. “When we are looking at a patient’s record, and we are on the MRI service, we are reading the MRI—but we are looking at CT, ultrasound, and plain films. The specialists are not going to do that. They are just going to look at their little piece of information and move on,” Rao explains. In addition, many departments employ a peer-review process for interpretations. At Jefferson University Hospitals, that entails sending data to the ACR® for benchmarking against data from other practices. “Do you think the other specialists would do that?” Rao asks. Patient/referrer