It’s Time for Radiology to Face the Patient

ChenThis post was contributed by Melissa M. Chen, MD, chair of the ACR Commission on Patient- and Family-Centered Care’s Economics Committee.

Last year, the Economics Committee of the American College of Radiology (ACR)’s Patient- and Family Centered Care Commission (PFCC) conducted the first-of-its-kind nationwide survey to gauge patient attitudes toward their imaging experience.

Prior to this survey, research was confined to individual hospitals or regions. Conversely, our sample included all demographics – race, region, socioeconomic and education level – and is therefore projectable for a variety of practices.

Since our committee is responsible for providing input in the development of value-based payment models and measures in patient-centered care, we wanted to determine if any gaps existed in radiological care and if so, how could those gaps be addressed?

Here’s what we found:

1) Patients recognized the importance of both the imaging procedure itself and the radiologist’s interpretation of the imaging. These two categories were rated higher than other parts of the experience such as “ease of scheduling,” “timing of the appointment” and the “check-in process” – a surprising finding.

2) Patients generally understood the role of the radiologist, but most patients reported having no interactions with a radiologist.

3) Quality of the imaging procedure and the potential positive impact the imaging can have on treatment and health outcomes were perceived to be more important than out-of-pocket costs, total cost of the procedure or even the billing process.

So what happens next?

Given the value patients inherently placed on the radiologist’s interpretation, there is a tremendous opportunity to drive positive perceptions of, and engagements with, radiologists. The main hurdle we must overcome is the relative lack of interactions that patients have with radiologists.

In today’s environment, we’ve seen the positive benefits of this in practice among radiologists who discuss biopsy results directly with patients in breast imaging centers. In these settings, whether in person or over the phone, the radiologist helps navigate patients with breast cancer through the system, by referring them to a breast surgeon, managing the surveillance of certain biopsy results and reducing uncertainty by answering questions.

These radiologists are integrated into a care pathway and work in multidisciplinary teams. A similar model is in place within the head and neck ultrasound clinic at Emory, where radiologists stage and follow patients with head/neck cancers, giving them same-day results on biopsies and helping to guide their care.

The challenge is getting reimbursed for the time these interactions may take, particularly as a diagnostic radiologist. Defining metrics that capture the value of these interactions may help as we move towards value-based payments. But lack of reimbursement shouldn’t stop us from increasing and improving our patient interactions now.

In fact, providing this added value to our patients is paramount if we are ever going to be able to achieve reimbursement. Why? Because it helps drive business towards the practice, both because patients may be bearing more of the cost, and because the practice can differentiate itself in a way that helps to secure and maintain hospital and insurance contracts and strengthen referring provider relationships. It also leads to better patient care and positive outcomes in the short term.

To enhance our understanding of patient and radiologist interactions, and to define metrics that patients value from these interactions, we have decided to focus on breast imaging, an area where these interactions are occurring more frequently.

Amy Patel, MD, vice chair on the PFCC Economics Committee, will lead these efforts to develop a survey for patients that could serve as an improvement activity under the Merit-based Incentive Payment System (MIPS). Our goal is that the defining metrics from the survey could be used in MIPS or Advanced Alternative Payment Models (APMs).

We look forward to building off of the first patient imaging survey to better understand potential patient and radiologist interactions, and to sharing our results with you.

  • Do radiologist-patient encounters take place in your practice? If not, what are some barriers you face to doing so?
  • What have patients told you they value most about your interactions?

Please share your thoughts in the comment section below or share them on Engage (login required).

Moving the Needle on Medical Imaging AI

IMG_1177This post was contributed by Bibb Allen Jr., MD, FACR, American College of Radiology Data Science Institute (ACR DSI) Chief Medical Officer.

This week, I had the honor of co-chairing the National Institute of Biomedical Imaging and Bioengineering (NIBIB)’s Workshop on Artificial Intelligence (AI) in Medical Imaging.

ACR DSI Chief Science Officer Keith J. Dreyer, DO, PhD, FACR and I led or took part in important sessions to clarify the needs in foundational and translational research for medical imaging machine learning.

We outlined the ACR DSI process particularly as it relates to AI implementation and stressed that:

  • The AI market is dependent upon both the development of AI algorithms and integration with current digital solutions (PACS, reporting systems, etc.)
  • DSI is working with industry and other professional organizations to create standardized AI use cases
  • AI solutions that do not follow AI use case standards will be slow to integrate into clinical practices

Proceedings from the workshop, which the ACR DSI co-sponsored, will ultimately be published as a research roadmap for healthcare and scientific professionals.

ACR Advocacy in Action will have much more on this important workshop next week.

  • Which AI implementation issues will have the greatest impact in the “last mile” before deploying AI clinical tools?

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


Keeping Up the Good Fight on CT Colonography

Dr. YEEThis post was contributed by Judy Yee, MD, chair of the American College of Radiology Colon Cancer Committee.

The American College of Radiology continues to press for wider private insurer coverage for screening CT Colonography (CTC or Virtual Colonoscopy) even as we work with patient and provider groups to secure Medicare coverage for CTC. Leaders from radiology, gastroenterology and patient advocacy will be holding a Congressional Briefing on Virtual Colonoscopy on September 12 in Washington DC.

Just this week, our efforts with private insurers resulted in another successful outcome.  Blue Cross Blue Shield (BCBS) of South Carolina is now among the growing list of private insurance companies that cover CTC to screen for colorectal cancer.

Largely due to ACR-led efforts, 37 states require insurance policies to cover virtual colonoscopy. Insurers that take part in federal exchanges are required by the Affordable Care Act to cover the exam with no patient cost sharing. CIGNA, Aetna, UnitedHealthcare, Anthem Blue Cross Blue Shield and others cover the test irrespective of ACA requirements.

You can help in this effort. I urge you to visit the ACR Colon Cancer Resources page. Use the tools and information there to show your referring providers how CT colonography can help attract their patients of screening age to get tested.

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