The 1999 Institute of Medicine report To Err Is Human¹ brought the extent and severity of medical errors to the attention of policymakers, hospital administrative staff, and health care providers. This landmark analysis sparked a broad change in the perception of how health care should be rendered to patients, with an increasing focus on safety and quality in the provision of medical care. Now, quality is the predominant theme in US health care policy, and nearly all medical specialties are under growing pressure to deliver high-quality services.
The use of radiology services is pervasive throughout hospital operations and patient care, yet radiology has historically received far less quality scrutiny than other specialties. To date, most public quality-reporting efforts have focused primarily on inpatient care. This lack of attention is due, in part, to the fundamental difficulties inherent in measuring true quality outcomes in imaging. When radiology is compared with other disciplines, such as infection control and cardiac surgery, payors and watchdog organizations have far fewer scientifically validated imaging quality measures at their disposal. Confounding matters further, assessing clinical quality in radiology requires a costly, labor-intensive period of retrospective review to determine how diagnostic imaging affected the treatment outcome.
Now, however, payors, CMS, regulatory agencies, professional societies, and radiology benefit managers (RBMs) have radiology quality in their crosshairs. Increased attention to quality presents imaging providers with several questions. What is the right response to quality pressure from CMS, payors, and RBMs? Are we measuring the quality of our imaging services accurately? What quality-improvement projects do we prioritize? What truly distinguishes a high-quality imaging provider? This year, The Advisory Board Co’s Imaging Performance Partnership, a strategic and best-practice research membership serving radiology departments at hospitals and health systems, conducted a six-month research study to address these challenges.
The past decade has seen unprecedented growth in imaging services, with many modalities growing more than 5% per year. At the same time, according to Verispan², the number of imaging centers has increased from 4,773 in 2001 to 6,414 in 2007. This growth has not gone unnoticed. In 2007, CMS implemented a technical-component payment cap for nonhospital imaging providers, as directed by the DRA. In addition, commercial payors across the country have adopted precertification and provider-privileging programs—now permanent fixtures in the radiology world—to curb advanced imaging utilization’s growth and to regulate provider networks, respectively.
With these measures in place, payors are now exploring new strategies for using quality measures to reduce utilization, influence provider selection, and regulate the number of imaging providers in the market. Imaging providers are now facing quality scrutiny on all fronts, each requiring a different strategic response.
Quality reporting: CMS already includes a handful of metrics related to diagnostic and interventional for the Physician Quality Reporting Initiative (PQRI). Now, CMS is proposing four reportable metrics for hospital imaging departments. In July 2008, the 2009 Hospital Outpatient Prospective Payment System proposed rule included four new metrics for inclusion in the Hospital Outpatient Quality Data Reporting Program.
The four measures are use of MRI of the lumbar spine, mammography call-back rates, and contrast use for pelvic and abdominal CT. Hospitals would be required to report these metrics to Medicare in 2009 to receive the full market-basket update in 2010, officially tying payment to quality reporting for hospital imaging.
The four measures primarily focus on utilization, and they signal CMS interest in generating more data to scrutinize the imaging provided to beneficiaries. In addition, as the National Quality Forum (NQF) is currently evaluating eight imaging-efficiency measures for official endorsement, more measures may be on the horizon.
Accreditation: Several payors, such as UnitedHealthcare, are now using accreditation programs to assess the quality of imaging providers. These programs set standards for physicians (both supervising and interpreting), technologists, and the imaging equipment itself. Most of these payors have