Patients First and Firsts for Patients

This post was submitted by James V. Rawson, MD, FACR, chair of the ACR Commission on Patient- and Family-Centered Care.

RawsonHeadshotThe saying goes that “every journey begins with a single step.”

The ACR is helping us take many first steps on the road to delivering high-value patient- and family-centered radiologic care. And, what better time to talk about them than during “Patient Experience Week.”

Most recently, we announced that attendees can be the first medical professionals to claim continuing education credits from the Patient Experience Institute by attending select sessions at ACR 2017 — The Crossroads of Radiology®.

Patients and patient advocates have been invited to attend and even present at ACR 2017. This provides a unique opportunity for us to gain direct insight on how they want to be cared for. In Washington, you’ll also see a large contingent of the #pinksocks tribe (more on disrupting health care later).

Radiologists don’t always have the opportunity to interact with patients — even though we know that such conversations empower them to make more-informed health care choices. In addition, a positive patient experience will be increasingly tied to reimbursement in coming years.

Patients are included as members in the PFCC’s four committees, which focus on economicsquality experience, outreach and informatics. This practice is being extended to other ACR commissions to ensure that we continue to include patient perspectives in College actions.

ACR offers numerous continually updated resources to help us move forward. This includes free access to a special collection of JACR articles to help radiologists innovate to deliver value to the doctor-patient relationship.

The PFCC will soon add a new committee — chaired by Cheri L. Canon, MD, FACR — to develop a unified educational strategy to move the concept of patient engagement and value (vs volume) into wider practice. That committee is developing the Radiologist’s Patient- and Family-Centered Care Toolkit to be launched at ACR 2017 and Radiology-TEACHES (Technology-Enhanced Appropriateness Criteria Home for Education Simulation) (more info coming soon).

I strongly urge you to become familiar with ACR resources to help us on our journey from volume- to value-based care. We are all in this together — and together with our patients — we are going to get there.

  • Idea exchange—Which types of resources are you looking for to enhance delivery of high-quality, patient-centered care?

 Please share your thoughts in the comments section below and join the discussion on Engage (login required).

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The AUC Boogeyman Is Not Real

Dr Thorwarth_20140414_008

William Thorwarth, MD

This post was contributed by American College of Radiology Chief Executive Officer William T. Thorwarth Jr., MD, FACR.

Health care is changing. From MACRA to ICD-10, the American College of Radiology (ACR) is addressing challenges that these shifts present and helping radiology transition to the new landscape. However, some changes do not present the challenges some suspect. They may actually help us with recurring issues.

For instance, pending regulations to be issued by CMS later this year, effective Jan. 1, 2018, the Protecting Access to Medicare Act (PAMA) will require referring providers to consult appropriate use criteria (AUC) before ordering advanced diagnostic imaging services (ADIS) — CT, MR, Nuclear Medicine and PET — for Medicare patients.

Providers can access imaging AUC at the point of care via electronic clinical decision support (CDS) systems or CDS software embedded in a physician’s electronic health record (EHR). Barring any changes by CMS, we anticipate providers documenting that they consulted AUC by entering a physician identifier that may be termed a “decision support number” (DSN) in the exam order. ACR developed CDS — ACR Select® (digital ACR Appropriateness Criteria®) — that can be integrated into most common EHRs. ACR Select is expected to meet PAMA requirements. CMS will announce approved CDS systems by June 30.

Imaging providers will not be competitively disadvantaged by this federal requirement.

No rendering provider can receive Medicare payment for ADIS if the referring provider does not properly document that AUC were consulted. All imaging providers can refuse such undocumented Medicare referrals. Imaging providers cannot perform AUC administrative duties for referrers (as many have with prior authorization). In other words, ordering physicians cannot shift the requirement to consult the guidelines to radiologists.

There is no facility “exempt” from these requirements to which providers can shift this Medicare imaging.

Due to rapid imaging growth in the late 1990s/early 2000s, CMS and private payers will continue to monitor and manage imaging utilization. The ACR offered the CDS/AUC solution to ensure appropriate imaging in a way that does not delay necessary treatment, interfere in doctor-patient decisions or penalize radiologists via arbitrary cuts.

By promoting CDS/AUC, radiology can position itself as a resource to hospital and health system administrators. This is a vital opportunity as medicine transitions from volume- to value-based care.

Communicate with referring physicians to ensure that they are aware of the forthcoming mandate.

Given the immediacy of this PAMA requirement, please take part in (with your referring providers) the CMS-funded Radiology Support, Communication and Alignment Network (R-SCAN™) — administered by the ACR.

Use R-SCAN to get familiar with CDS/AUC and obtain continuing medical education (CME) Credit and American Board of Radiology (ABR) maintenance of certification Part 4 Credit.

Also, please read the new ACR Clinical Decision Support (CDS)/AUC Frequently Asked Questions document.

Changes to the AUC program can be monitored through the CMS website. Please also monitor the ACR website and read the Advocacy in Action eNews, where additional information will be published.

  • How are you preparing for CDS/AUC?
  • How have you communicated about the federal requirement with referring physicians?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Radiologists Are Essential

The following post was contributed by Kevin M. Rice, MD, a radiologist in Los Angeles, Calif.

Rice_Kevin_edWhat happens if you type in the Google search box: “radiologists are …”? Chances are you may see something like the below screenshot. Wouldn’t you prefer to see: “radiologists are essential”?

We are the only physicians specially trained in patient diagnosis and care through medical imaging. We save lives and health care dollars by detecting diseases early and pinpointing effective treatment for cancer, heart disease and many other diseases. As radiologists, we are a crucial part of the delivery of patient-centered heath care, and we need to be proactive in relaying this truth.

If we stay in our reading rooms glued to our monitors, others will write our narrative. And, we may not like the story that they are telling.

So, what can we do to inform others about our vital role as radiologists?Essential_ed

Ask yourself the following.

  • Are you a valued as an essential member of the health care team? Or, do you show up hours or later just to provide a perfunctory entry into the medical record?
  • Are your reports succinct and actionable? Or, are they so full of hedges they are rendered meaningless?
  • Are you engaged in the medical staff affairs of the hospitals or health care plans you service? Or, are you on the sidelines letting the decisions that affect you and your patients be made without any radiology input?
  • Are you interacting with your patients in a consequential way? Or, are you invisible to your patients?

If you need help, the American College of Radiology (ACR) provides numerous resources (covering, for example, Imaging 3.0, the Radiology Support, Communication and Alignment Network (R-SCAN) and patient- and family-centered care) to help us take a leadership role in shaping America’s future health care system.

What are you doing in your practice as a radiologist to be certain you are considered essential?

Please share your thoughts in the comments section below and/or join the discussion on Engage (login required).