The Radiologist and Population Health Management

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 - April/May 2015

Far from being marginalized, radiology can survive and thrive as one of the most valuable players in a population health world, but it will need to prove its strategic value to health systems.

The concept of population health management is often spoken of as a solution to the perverse incentives inherent in fee-for-service payment that encourage turf battles between specialties and quantity of care over quality of care. As much as radiologists will agree on the need for more appropriate utilization of imaging services, greater efficiency and more collegiality between specialties, the idea is also anxiety inducing.

The reason radiologists worry about population health is a good one. When the concept of managing the health of a population of patients is linked to a payment model such as the global payment or capitated model, it flips the traditional radiology business model upside down. Radiology procedures, tests and related services that used to be revenue centers become cost centers within the organization.

Nonetheless, the specialty can survive and even thrive on its strategic value rather than being a direct source of profits, say experts Radiology Business Journal consulted for this article. It will, however, require a new and possibly 180-degree-different practice model.

Radiology as strategic cost

One population health expert who is confident about radiology’s ability to adapt to population health is Paul J. Chang, MD, FSIIM, professor and vice chair, radiology informatics, University of Chicago School of Medicine, as well as medical director of both enterprise imaging and service-oriented architecture (SOA) infrastructure at the University of Chicago Hospitals.

“Radiology can thrive and should thrive as a cost center,” he says. “This fear that people talk about of moving from a revenue center to a cost center, which will happen, is actually an opportunity. It just means that we will have to change. IT is the perfect example. IT has been a cost center from day one. Who has the biggest budget? IT. Our department has one of the biggest budgets in the hospital these days, and we pay our people very, very well, because we are strategic. We are critical to the mission.”

In his view, there are four main ways radiology can participate in population health and survive on its strategic value to the enterprise.

  • Advising other doctors through a range of consultative services and acting as a gatekeeper on healthcare services.
  • Assuming responsibility for disease surveillance.
  • Directing decision support systems, including overseeing the implementation of clinical decision support (CDS) tools as part of computerized physician order entry (CPOE).
  • Applying radiology’s background in analytics to the enterprise level of an organization

However, at this point, relatively little of this is being done, Chang says, because the U.S. healthcare reimbursement system is in a gap period where even though there is a lot of talk about population health and possible new reimbursement models, the primary payment model is still fee-for-service.

“People tend to be very rational and they are not going to pull the trigger on a change in world view unless it is necessary to do so,” he says. “When people talk about the declining role of radiology in population health, my response is ‘stay tuned.’ This is all still, in many ways, our future.”

Living in a fee-for-service world

Work already is underway at forward-thinking institutions to improve care efficiency, quality and safety, as providers strive to meet quality incentive payments in the fee-for-service world and begin to take on capitated contracts and global payments in a population health world.

The University of Chicago, for example, is building a database of incidental findings recovered from radiology reports, of which only 30% are being followed up on, Chang says. If a recommended follow-up test or procedure is not ordered, the application can escalate matters all the way up to sending a certified letter directly to the patient about the finding and next recommended steps in care.

This application is part of an overall enterprise infrastructure initiative at the University of Chicago called Enterprise Informatics and Analytics. The same infrastructure also supports breast imaging communication and escalation.  Chang notes that this may be a model for how radiology will someday take ownership of disease surveillance in a population of patients instead of simply trusting that other physicians