Quality and Contract Negotiations: Putting a Price on Quality

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As medicine moves from fee-for-service reimbursement into newer models that aim to reward quality of care over quantity, the issue of what quality looks like in radiology and, even more importantly, what it is worth in contract negotiations is becoming a critical one. Hospitals and healthcare systems facing their own issues with quantifying quality of care for newer outcome-based reimbursement models are starting to look for similar data from the groups they contract with.

Yet, even as interest in measurable quality of care grows, it is challenging to make a case that radiology-specific quality measures should be financially rewarded if they are high, or conversely, penalized if they are low. The connection between fast and accurate diagnostic imaging results and superior patient outcomes is just much harder to make than simple primary care correlations between adherence to preventive care and disease management guidelines and overall patient health and lower care costs.

Not surprisingly given this reality, many of the Physician Quality Reporting System (PQRS) data radiology groups or their hospitals must now report to the Centers of Medicare and Medicaid Services (CMS) are measures related to imaging utilization, dose management or reporting processes (see sidebar). The ultimate quality measure—the contribution of the radiology practice, center, or department to the best possible outcome for the patient—is not as easy to define in a measurable way. Some practices, however, are trying to define and demonstrate quality in ways a bit broader than just the PQRS measures, accreditation, or rankings on patient satisfaction surveys (see sidebar).

Changing the conversation

“We do Press Ganey [the patient satisfaction survey], survey our referring physicians, and track key clinical values, but we need to do a better job of defining what quality is in radiology,” says Alicia Vasquez president of California Medical Business Services, LLC, which manages Radiant Imaging and its two divisions, The Hill Medical Corporation in Pasadena and Glendora, California, and Arcadia Radiology Medical Group in Arcadia, California. “[On Press Ganey surveys], patients will rank imaging services on whether the center provided free parking at the facility or how quickly the patient could schedule an appointment, not the quality of the physician who read the study. Was he/she subspecialized? Was he/she fellowship trained? Was it done on a scanner that has met ACR criteria?”

The 26-radiologist practice Radiant Imaging and its affiliates are part of Strategic Radiology, a consortium of radiology practices across the country that collaborate on issues such as quality and share best practices through an Agency for Healthcare Research and Quality-designated patient safety organization (PSO). Vasquez applauds Strategic Radiology for deepening the investigation into what constitutes quality in radiology.

As a Strategic Radiology member practice, Radiant Imaging can address quality in a broader, more meaningful way that encompasses all elements of the practice’s quality profile, including clinical quality, image quality, operational quality, patient experience, physician quality, risk management, and compliance, in partnership with other Strategic members and hospitals. “We have to have a singular voice, because if everyone speaks about quality in a different language, we are not going to get the message across,” Vasquez says. “Strategic Radiology has tried very hard to help define what a highquality radiologist is.”.”

However, as of yet, Radiant Imaging has not had any national payors provide additional reimbursement for providing measurably higher quality imaging services, nor has Radiant Imaging received additional compensation for professional services for meeting performance targets. The flip side of that, of course, is she that Radiant Imaging does not bear any financial risk for not meeting certain quality metrics, but Vasquez knows it is coming.

“[The major national private payors] just don’t have a methodology or mechanism in place to track quality and dovetail that into reimbursement rates,” she says. “The payors have mechanisms to track utilization and other metrics, but they don’t have a manner to track quality and that is unfortunate. Most imaging providers will say the same thing, that they have the best quality. The tough part is to try to measure and articulate that back to the payors.”

What practices are doing

Radiant Imaging is not alone