Pursuing Real-World Strategies for Practice Transformation at the ACR-RBMA Practice Leaders Forum

ACR17-136Samir B. Patel, MD, FACR, diagnostic radiologist, Radiology, Inc. contributed this post.

I was honored to serve as faculty for the ACR-RBMA Practice Leaders Forum this past weekend. It’s a great opportunity for a diverse group of radiology and business leaders to come together to learn, network and solution-build. As the creator of a value management program in my own practice, I’m a staunch advocate for value-based practices. I also understand that strategy is just one of many building blocks that can help manifest a successful radiology program.

To be an efficient practice leader in the realm of radiology, you must first understand the economic and cultural factors driving change.

The Practice Leaders Forum connected me with fellow colleagues and business experts to collaborate and develop strategic solutions to address the changes coming down the pipeline. Together, we addressed several big-ticket items including the 2020 final Merit-based Incentive Payment System rule (MIPS), recruitment, performance metrics, augmented intelligence (AI), physician well-being, clinical decision support and dealing with adversity.

In one of the first few sessions of the weekend, Drs. Barbara F. Rubel and Nancy Fisher covered the future of MIPS and the Quality Payment Program in 2020. This year, the MIPS payment adjustments are expected to rise alongside the increasingly vigorous requirements. As a result, cost will become a higher percentage of an eligible clinician’s composite performance score, and payment adjustments will be higher for strong performers – yet high scores will be more difficult to achieve. Drs. Rubel and Fisher urged attendees to use these changes as opportunities to work directly with facilities to manage patient costs.

In my breakout session, co-facilitated with Sheila S. Witous, MBA, CPA, CGMA, we discussed desirable attributes of performance measures. Participants then worked in small groups to come up with one value metric and one business metric which are not used as performance measures currently but would be of value. The discussion among the participants was rich and energetic with several wonderful ideas generated.

As my co-faculty Frank J. Lexa, MD, MBA noted, “Teams are a key factor for success (or failure) in radiology.” It’s important that as we lead, we also reserve time for reflection: on what’s working and what’s not, who will help achieve the desired results, and if we have the expertise and resources we need to make it happen. All the while being the first to recognize burnout in our groups and intervene.

If you’re a radiology leader looking to optimize your practice performance, I encourage you to equip yourself with management strategies tailored especially for the radiology environment. Take advantage of radiology-specific resources available through the Practice Leaders Forum, and take the next step in ensuring success in your practice.

  • Interested in attending the 2021 ACR-RBMA Practice Leaders Forum? Registration is now open.

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What Can Your Medical Physicist Do for You?

Marsh_RebeccaRebecca Marsh, PhD, associate professor & medical physicist at the University of Colorado School of Medicine, contributed this post.

The role of the medical physicist is diverse and extensive—but sometimes not well-defined. Some medical physicists are well-integrated into hospital operations while others work off-hours so as to not disrupt clinical operations. In either case, it can be easy to miss some of the specialized knowledge and training that clinical medical physicists have and the myriad of ways health care facilities can take advantage of their physicists’ knowledge to improve quality and patient care.

If you work with diagnostic imaging equipment, there is probably a medical physicist who supports clinical use of this equipment. Do you know who your medical physicist is? Here are a few general characteristics to help you spot clinical medical physicists:

  • Has a graduate degree (either an MS or PhD) in science or engineering;
  • Has completed a three-part process, earning ABR certification in Diagnostic, Radiation Therapy or Nuclear Medicine Medical Physics*;
  • Often has completed a two-year clinical residency;
  • Has an extensive background in general math, science, computers, data analysis, PACS and informatics and (often) research design.

Diagnostic medical physicists are extensively trained in how imaging equipment works, the underlying mechanisms for image artifacts, clinical applications, radiation dosimetry, radiation biology and clinical applications of various imaging modalities.

So, what can your diagnostic medical physicist do for you? While known for testing and calibrating imaging equipment – measuring radiation output and evaluating image quality – we have so much more to offer, including but not limited to:

PlanningWe can be useful when selecting new equipment or planning a new site. For example, we are well-versed in how technological advances affect image quality and dose. We also understand public exposure limits and can often help design clinical layouts so that the amount of room shielding (and cost) is minimized.

Protocol optimizationWe know a lot about how imaging equipment works. Our physics testing includes learning about the settings and characteristics of each individual piece of equipment and how changing these settings affect radiation output and image quality. We can help you get the most out of this very expensive equipment.

Radiation riskWe spend a lot of time thinking and talking about radiation, and we care deeply about the safety of patients and staff. Some of us may send you that annoying friendly reminder when your dosimeter readings increase a bit, but we do it because we care. Our expertise can be useful in developing hospital policies, optimizing imaging protocols and communicating with staff and patients. Wondering how the scanner-reported DLP corresponds to patient skin dose during a CT-guided interventional procedure? Have questions about how much dose a fetus gets during an abdominal CT scan of the mother and whether the child is at increased risk of fetal malformation or childhood cancer? Ask your medical physicist.

The next time you see yours, ask him or her how you can work together to improve patient care and safety.

*Some over-achievers are certified in more than one specialty.

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It’s Time to Ditch the Disk: On Trauma


Mathieu _JeannetteJeannette Mathieu, MD, University of California at San Francisco, and Israel Saramago, MD, University of North Carolina at Chapel Hill, contributed this post.

Opinions are the authors’ own and do not reflect their institutions’ opinions.

Time is critical when caring for trauma patients. Injuries with high morbidity and mortality, such as intra-abdominal hemorrhage, spinal cord compression or pneumothorax, often develop and progress rapidly. Emergency and trauma physicians rely on radiologists to quickly identify these injuries in order to guide lifesaving treatment decisions. Instantaneous digital image sharing can dramatically improve timeliness of patient care, particularly in the trauma setting.

Critically injured patients frequently undergo initial workup at smaller, local hospitals before transferring to Level 1 trauma centers for specialized treatments, such as emergency neurosurgery to decompress a brain bleed, vascular surgery to repair a ruptured aorta or interventional radiology to embolize an uncontrollable pelvic hemorrhage.Saramago_Israel

Relying on CDs to share images can cause delays in care, as the disk must be physically sent to the new hospital and uploaded to PACS before a radiologist can review it. Sometimes, patients are re-scanned at the new hospital due to their CDs being unavailable or corrupted. Digital image sharing allows referring hospitals to immediately send images to trauma centers so that radiologists can expedite treatment planning by evaluating an unstable patient’s imaging while the patient is en route.

In addition to facilitating transfers, digital image sharing provides rapid access to a given patient’s prior studies regardless of where they were performed. This can help radiologists discern which findings are chronic versus acute. For instance, radiologists commonly recommend additional CT angiogram and MRI to evaluate the vasculature and ligaments, respectively, in patients presenting with acute cervical spine fractures. However, old fractures can sometimes mimic acute fractures. When the chronicity of a fracture is equivocal, prior images can determine which are old and warrant no further work-up.

Creating and sending CDs between facilities is an unnecessarily slow and unreliable method of sharing time-sensitive data. Duplicating imaging studies patients have already received elsewhere or inadvertently ordering additional unneeded studies because prior images aren’t available to establish the chronicity of a finding is wasteful and can cause unnecessary radiation exposure. These practices can be greatly reduced by switching to digital image sharing.

Join us on our journey to #DitchTheDisk and improve the standard of care for trauma patients. The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark attempt to improve the method of imaging transfer. To get involved, please fill out this form or email ditchthedisk@acr.org.

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