Quality and Affordability: It’s Not Either/Or

Nicola_GThis post was contributed by Gregory N. Nicola, MD, FACR, vice chair of the American College of Radiology Commission on Economics.

The Quality Payment Program places importance on improving quality and also lowering cost. While quality and cost are related, it is possible to improve one and not necessarily the other. The good news is that radiology can ultimately help do both.

We have to start stressing to the radiology community that quality is difficult to measure. We have decent — and are working on better — quality measures, but they may not necessarily be understood by our referring provider colleagues.

The one thing that is understood, though, is cost. As a specialty, we need to do all that is realistic to control those costs. This may include participating in R-SCAN, encouraging clinical decision support (CDS) use to ensure studies are appropriate, or adopting standardized templates and recommendations to reduce variability of follow up on incidental findings. Hopefully, artificial intelligence (AI) application will also further advance our ability to reduce unnecessary care and variance.

Ultimately, one of our primary values to our patients is to prevent unnecessary utilization of medicine and potentially of advanced imaging. In addition to all the quality aspects of participating in MIPS, radiologists can do more to help control costs and improve quality of care.

  • What are some ways you are raising quality and controlling costs in your practice?

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Why #Radvocacy and Organized Medicine Matters for Future Radiologists

MalhotraThis post was contributed by Gunjan Malhotra, MD, radiology resident, University of Michigan Class of 2021 and newly elected vice chair of the American Medical Association Residents and Fellows Section.

My introduction to, and passion for, advocacy and organized medicine began during my first year of medical school in Detroit, where the Wayne State University School of Medicine’s curriculum specifically aimed to expose medical students like myself to medical advocacy. It was through that curriculum, and organized advocacy days at our capitol in Lansing, MI, that I realized the importance of policy and legislation to the practice of medicine.

It was also during my first year of medical school that I attended my first American Medical Association (AMA) meeting, where physicians and physicians in training from all over the country – representing more than 130 national medical societies, military service groups and professional interest medical associations – came  together to discuss policy pertinent to our practice and patients.

My involvement with the AMA revitalizes my passion for medicine every year. I have found lifelong friends and mentors from across the country, and have been able to collaborate on a number of resolutions over the years on topics related to patient care and physician practice.

My experiences also led me to find the American College of Radiology (ACR) delegation as a fourth year medical student, which has now become my home within the AMA as a resident. The ACR delegation has shown me the power of working together with physicians from other specialties as a united physician organization. In the end, we all share the common goal of providing the highest quality care for our patients.

Through the support of my fellow resident and fellow colleagues in the AMA, the ACR and the Michigan State Medical Society, I was recently elected vice chair of the AMA residents and fellows section for 2018-2019. I look forward to representing the radiology community, my state society and the residents and fellows in this role.

As radiologists continue to support clinical decision tools, advance the use of appropriateness criteria to determine the most appropriate imaging or treatment decision and lead the way with AI, we will show our physician colleagues the true value radiology brings to medicine. 

  • When were you first introduced to the importance of medical advocacy in radiology and across specialties?
  • How are you collaborating with other physician colleagues to deliver the best care for your patients?

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

Radiology’s Role in Health Care Extends Well Beyond the Dark Room

ACR-18This post was contributed by Arl Van Moore, Jr., MD, chair of the ACR Delegation to the AMA House of Delegates.

At the American Medical Association (AMA) Annual Meeting in Chicago earlier this week, Scott Ferguson, MD, founder of Outpatient Radiology Clinic in West Memphis, Arkansas, was elected to the AMA’s Board of Trustees. I am proud to announce that radiology now has a voice not only on the Board of Trustees, but also on four of the six AMA Councils.

Other members of the AMA Radiology caucus have taken on the following leadership roles after being elected at the A-18 AMA meeting:

  • Kevin Reilly, MD (KY) – Council on Constitution and Bylaws
  • Sheila Rege, MD (WA) – Council on Medical Service
  • Gunjan Malhotra, MD (MI) – AMA RFS Vice-Chair

And two radiologists already serving on AMA councils are:

  • Jacqueline Bello, MD (NY) – Council on Medical Education
  • Alex Ding, MD (CA) – Council on Science and Public Health

The American College of Radiology (ACR), the AMA and these elected leaders each recognize the importance of collaboration across specialties with respect to improving the delivery of patient care. As health care in the United States moves increasingly toward value based, patient- and family-centered care, radiologists have unique opportunities to improve the patient experience, reduce and eliminate unnecessary procedures and maximize value. We are leveraging the ACR Appropriateness Criteria to help referring physicians make the most appropriate decisions for specific clinical conditions. We’re learning from case studies like this recent example in suburban Philadelphia, where radiologists and emergency department physicians used the Radiology Support, Communication and Alignment Network (R-SCAN)™ to achieve a 45 percent improvement in appropriate CT ordering for pulmonary embolism.

Both the AMA and the ACR are also increasing efforts to engage with medical students and better prepare the next generation of doctors for the opportunities and challenges they will face. Nearly every hospital patient will undergo some type of radiological exam, yet undergraduate medical education curricula often don’t include comprehensive instruction on appropriate imaging. This results in some patients experiencing unnecessary imaging, radiation and costs. The web-based program Radiology-TEACHES uses case vignettes in ACR’s CORTEX integrated with the CareSelect™ clinical decision support (CDS) tool to simulate the image ordering process and educate learners about appropriate imaging.

No matter where we as radiologists fall on the continuum of an individual patient’s care, we possess a unique opportunity to break down silos and enhance collaboration that leads to better outcomes. This is true not only within radiology but also across specialty lines as we work with colleagues in different referral specialties. It will require good leadership within our specialty as well as a commitment to teamwork to help bridge these gaps and develop these teams. This representation at the AMA will help us accomplish that!

  • How are you working to collaborate across specialties and build health teams to achieve better outcomes for your patients?

Please provide your thoughts the comments section below or on the Engage discussion board (login required).