All Politics Is Local – Action Needed

The following post was contributed by Geraldine McGinty, MD, MBA, FACR.

You should have received (or at least seen) a notice this week from the American College of Radiology (ACR) urging you to tell your senator to support legislation to repeal and replace Medicare’s flawed Sustainable Growth Rate (SGR) formula. I strongly encourage you to take advantage of the automated system ACR has put in place to help you do this.

I would remind all of us that, while ACR volunteers and staff do a fantastic job of representing us in Washington and at the state level, we need to work together to support these efforts to make medicine better. And the famous saying “all politics ‘is’ local” still very much applies.
Many are still uncomfortable with this sort of thing, but as the federal government and even some states consider emerging health care payment and delivery models, making our voices heard is only going to become more important.

This is why several sessions at ACR 2015™, the College’s all-new, all-radiology annual meeting will show us how to better advocate for our patients and practices in our communities and at the state and federal levels. As the meeting is in DC, we can also see our legislature at work and have the opportunity to help impact health care delivery and policy. On Wednesday at the meeting, radiologists head to Capitol en masse to meet with our elected representatives and tell them first-hand how we make high value health care better.

There is a clear link between these visits and initiatives that align incentives and improve care for our patients. In 2013 attendees used a beta version of ACR Select to show lawmakers the way that the ACR’s Appropriate Use Criteri® a can drive value in imaging. Less than a year later, the Protecting Access to Medicare legislation was passed requiring referring physicians to use appropriateness criteria based clinical decision support to prescribe advanced imaging scans for Medicare patients.

I know our Congress can seem dysfunctional at times but I get such a buzz from watching democracy at work and thinking about how we as physicians can leverage the political process to make sure that our patients get “all the imaging that is beneficial and necessary and none that is not” (Bibb Allen, Imaging 3.0™).

We can make such a difference and you can be a part of that change. I hope you will contact your  Congressman about the SGR bill and I hope to see you in DC!

Finding Opportunity to Provide Patient-Centered Care in Response to Breast Density Legislation

The following post was contributed by Courtney L. Sullivan, MS, RRA, RT (R), RDMS, CN-BI

Through a lay letter notification that was sent in the mail, a woman receives her mammogram results to discover that everything is normal. Relieved, she makes a note in her calendar to schedule her annual screening exam in one year, and then she reads the following:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician.”

What does she do now? The above notification is verbiage required by New York State law that mandates radiologists to inform patients if they are found to have dense breast tissue. In January 2013, New York State joined the many states that have passed breast density legislation laws.

Although these laws are increasingly being enacted across the country, there are no evidence-based guidelines to support additional screening options for dense breast tissue, and also no guarantee of insurance coverage. As a result, breast density notifications often lead to confusion for both patients and their referring physicians.

Patients often turn to their referring physicians to answer questions, yet it is the radiologist that has the most expertise in breast imaging and additional screening for dense tissue. While these laws are currently mandated on a state level, a proposal has been made to make breast density notification a federal standard which implies that this is a topic that is only going to become more pressing.

In attempts to ease some of the anxieties and confusion around breast density, the radiology department at Weill Cornell Medical College at NewYork-Presbyterian Hospital developed a consultation service for patients and their physicians. The department recognized a lack of education surrounding issues of breast density and saw an opportunity to get patients involved in their own care.

The consultation service, formally known within the institution as WiCare (Weill Cornell Imaging Consultation and Radiologic Expertise), consists of one RRA (Registered Radiologist Assistant) and 12 breast radiologists that work together to ensure that patients have the resources to make well informed decisions.

A study described in an article recently published in Clinical Imaging examined the initial experience with the radiology consultation service and found that consultation was successful in increasing patient confidence and perception regarding breast density, ultimately facilitating communication between patients and their providers.

While there was room for improvement, over 78 percent of patients felt that after undergoing consultation they had enough support to make a decision. On an optional survey distributed anonymously post consultation, one patient commented, “everything was clearly explained, and any concerns were addressed with care.” Others stated that they felt much more knowledgeable and at ease, and that all options were thoughtfully posted.

Since implementing breast density consultations, WiCare has expanded consultation efforts to other areas in radiology offering a range of services that include imaging ordering assistance for referring physicians, synthesis of outside imaging studies and resident-driven imaging rounds. The key to effective consultation is quality and efficiency, and with current fee-for-service payment models this has continued to be a concern in terms of the radiologist’s time and productivity.

Different from radiology consultation services attempted in the past, WiCare utilizes the RRA role allowing the radiologist to spend the most efficient quality time with patients and physicians for all consultation activities. With the ultimate goal of creating an environment that is patient-centered, all elements of the consultation service encourage communication in the shared decision making process between patients, physicians and radiologists to increase quality of care.

The Time Is Now: Get Ready for CDS

The following post was contributed by Lawrence A. Liebscher, MD, FACR.

Jan. 1, 2017 seems like a long way off. That is when new rules go into effect requiring physicians to consult a Centers for Medicare & Medicaid Services (CMS) approved clinical decision support system, such as ACR Select™, to order advanced imaging exams for Medicare patients.

While it’s 22 months from now, it is but a blink of an eye in IT time. The larger your hospital or health system, the longer it will take to move a new IT project from inception to operation. My health system went live with ACR Select on Feb. 17, 2015 – 2 1/2 years after the concept was first introduced to key administrators.

ACR Select is a cornerstone of Imaging 3.0™. Its deployment will need to be led by radiologists, but it is fundamentally a clinical system embedded in the electronic health record (EHR). As such, it will likely require approval by one or more clinical governing bodies. It will need to be included in the IT budget and fit into the annual IT work schedule. You will need to assemble stakeholders and develop a formal business plan. All of that takes time.

Do you know?

  • The approval process in your institution?
  • When those bodies meet?
  • The key people that must be involved?

Also, do you know?

  •  When the IT budget and annual work plan is approved?
  • What deadlines you must meet?

A number of informatics and innovation sessions at ACR 2015™, the College’s all-new, all-radiology annual meeting, can help you better understand the CDS process and make your implementation efforts more efficient.

These sessions include:

You can also check out the ACR Informatics and Innovation “Toolkit” for more information regarding CDS and to prepare for the ACR 2015 informatics sessions.

The time to begin seriously working on the implementation of ACR Select is now. Tempus fugit.