Radiology’s Burning Platform

There’s a fire down below, and it’s not global warming.

The CEO of the ACR, William T. Thorwarth, MD, stood before an audience at the Radiological Society of North America (RSNA) and suggested that radiology’s platform is on fire—or getting quite warm—to convince those in attendance to waste no time in initiating change. What is the most important factor that will drive change over the next decade? Accountability.

That Thorwarth invoked the business lexicon for a dire situation that requires immediate and radical change is a good measure of the gravity with which he views the issue; read a bit more about his position here. In identifying accountability as radiology’s potential Waterloo, he does the specialty a great favor. New business models will emerge in healthcare over the coming decade, and all physicians will be challenged to demonstrate their accountability to care. Radiology, however, has a unique challenge—detachment.

In the first wave of pay for performance—or, more precisely, penalties for failure to hit quality marks—hospitals are taking the brunt of change. Failure to ace the Hospital Consumer Assessment of Healthcare Providers and Systems survey is no laughing matter for the many hospitals that have sacrificed dollars to lower than average scores. Some of these hospitals rank among the nation’s most celebrated; some can ill afford the penalties, putting them further behind the profitability eight-ball and rendering them even more vulnerable than before.

After nibbling on a few carrots during the past few years, physicians will feel Medicare’s stick for the first time in 2015, with 1.5% penalties on Medicare reimbursement for physicians (in practices of 100 or more) who failed (in 2013) to participate in PQRS. Perhaps you think that the effort expended to meet payor quality metrics are diverting attention from more important quality-improvement endeavors. Forget about the measures for a moment (and precisely how radiology will demonstrate accountability): The measures will change after they are met. Consider the detachment issue.

Detachment from the patient. In an effort to avoid the abuses of 90s-era managed care, the architects of healthcare reform made patient centeredness its central construct, leaving radiologists feeling somewhat adrift in the new paradigm. Radiologists are very much connected to the patient, of course, but for the most part, the patient is unaware of the contribution the radiologist makes to his or her care—until the patient gets the bill for professional services.

Now that the patient is paying a bigger portion of the bill, this is not the best introduction to the radiologist. Radiology has unique hurdles to clear in connecting and building its relationship with a customer segment that has increasing clout in the specialty’s customer matrix.  Proactive radiology practices and departments are invested in building patient engagement. You know this, you’ve heard it all before: Delay action at your own risk.

Detachment from the care episode. The lack of direct patient contact has different implications for hospital, referrer and payor relations. Referring physicians are aware of the radiologist’s contribution to care, and in fact depend on that service. Do they value it, or do they take it for granted?

As radiology attempts the valuation of that contribution, an obvious place to begin is to start closing the loop on the interpretation and, in the case of the interventional radiologist, the treatment. Aside from mammography, are you aware of your false positive rate for other imaging services? Are your interventionalists following up (at bedside) with the patient after a chemo-embolization?

Read-and-run interpretation is looking a bit shopworn. The days of banging through a stack of studies and sending them into a black hole have officially ended. The potential for radiology to find new ways to extract, analyze and interpret the data generated by its wondrous imaging modalities is no less than thrilling. Outcomes are the endgame, but on the way to that destination, radiology will navigate through multiple endpoints (metrics).

Expect a significant amount of trial and error on the way to the Emerald City, as our coverage of early experiences with clinical decision support (CDS) in the Medicare Imaging Demonstration (MID) indicates (page 42). Consultation of CDS prior to ordering advanced imaging is a Congressional mandate and something many in radiology—myself included—have advocated for more than a decade. The experiences of MID participants emphatically suggest that this is not simply one of those technology fixes for which radiology has a proclivity. Engage early and make sure your referrers, hospitals and patients benefit—as they surely will not without your involvement.

The advantage of having a tremendous challenge is the potential of having a tremendous impact—on service, quality of care and accountability to that care.