The Diagnostic Radiology Consultation Clinic: A New Prospect for Patient-Centered Radiology

Health care is changing and momentum is building around patient-centered care. As radiologists, we are uniquely positioned to support this transformation. Imaging is vital to understanding the implications of costly public health conditions such as atherosclerosis, hepatic steatosis, and emphysema. As specialists in imaging and as doctors, we have a unique understanding of the contributing factors and expected outcomes if these diseases go unchecked.

While we have a comprehensive perspective of these common diseases, including the expected evolution and outcome, we aren’t the ones typically communicating with patients. Regardless of how many times patients are told by their primary care clinicians to diet, exercise or take medications to treat these conditions, the concepts are too abstract and too often don’t result in meaningful change.  Here is where we step in and change outcomes. Consulting diagnostic radiologists could empower patients by showing them their images, placing their disease in context, and motivating them to change their habits.

“This is crazy talk! Are you suggesting a consultation clinic where a radiologist motivates patients to eat healthy, exercise, and take their medications?” Well, we have started a clinic doing just that.  I can tell you personally not only does showing patients their images motivate them to improve lifestyle habits, but it’s also fun, incredibly rewarding, and a way to reconnect the countless images you see on a screen every day to the patients’ lives we impact.  We also increase visibility with patients, support referring physicians, and demonstrate value to the health care system. Check out my next blog post to learn more about the details of our diagnostic radiology consultation clinic.

Mark D. Mangano, MD is a first year radiology resident at Massachusetts General Hospital in Boston.

Visiting Capitol Hill

One of the most intimidating experiences in my life was the first time I walked into a U.S. senator’s office to lobby for my specialty: radiology. I had attended the ACR Annual Meeting and Chapter Leadership Conference (AMCLC) meeting in Washington, DC, for the first time and spent the past several days at the conference listening to lectures about the latest concerning legislation, which at that time was the Deficit Reduction Act (DRA). Fueled with all the knowledge I had acquired and armed with the talking points given to me by the ACR’s Government Relations Department at the meeting, I joined my fellow state representatives at the conference and walked into our state senator’s office.

I was a little nervous at first. I wanted to make sure that our concerns were well represented, and that I said everything in a way that the representative not only understood the issues, but more importantly, would know how critical our concerns are to not only radiologists but to the patients who we care for.

We sat at an oval-shaped table and were greeted by the senator’s legislative assistant. Each member of my group took turns discussing with the assistant the impact that reimbursement cuts would have — not only on the practice of medicine but on a patient’s ability to access imaging. I felt for those 10 minutes or so while we discussed our concerns that I was helping to make positive changes and was taking a proactive role in molding the future of radiology.

Almost 10 years later, and 10 AMCLC meetings later, at each Capitol Hill visit that I have done I continue to feel like I am a contributor to safeguarding my specialty and making a difference. I highly recommend that every radiologist attend AMCLC and make your voice heard. Strength comes in numbers and when we come together changes can happen.

Jennifer Nathan, MD, is a neuroradiologist at Fort Belvoir in Washington, DC.

Medicare Coverage for Low Dose CT Lung Cancer Screening Battle Ongoing

The National Lung Screening Trial was initiated as early as 2002. In 2010, initial result were published in the New England Journal of Medicine (NEJM). The study was closed early because of the conclusive findings of at least 20 percent mortality benefit with low dose CT screening in the high risk population.

In December 2013, the United States Preventive Services Task Force (USPSTF) determined that lung cancer screening indications were a “Grade B” for high risk individuals. The Affordable Care Act (ACA) requires that private insurers cover all medical exams or procedures that receive a grade of “B” or higher. The ACA, however, does not specify that Medicare provide the same coverage.

The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) met on April 30. Those opposed to low dose lung cancer screening argued that the money is better spent on smoking prevention programs. MEDCAC’s scoring of CT lung cancer screening reflected a recommendation against covering seniors for the test.

So now we have two government advisory bodies on opposite sides of an issue. We have a two-tiered system where many privately insured patients are getting the imaging that they need, and is indicated, while Medicare beneficiaries may be denied coverage.

ACR maintains clinical research as one of its fundamental pillars. Research is critical for the profession and our patients. We stand with nearly 40 other professional societies and alliances in urging Center for Medicare & Medicaid Services (CMS) to cover seniors for these proven lifesaving exams.

The radiology community will have an opportunity to weigh in again when CMS makes its recommendations in a proposed decision memo – scheduled to be released Nov. 10, 2014. We may seek legislative options as well. As before, we will be relying on your grassroots support to help underscore the effort.

Howard B. Fleishon, MD, MMM, FACR