Optimizing Patient Care Requires Teamwork, and Radiology Can Be the Team Captain

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This post was contributed by Ryan Fitzgerald, MD, and Scott Harter, MD, of Radiology Consultants in Little Rock, Arkansas.  

Radiology is as integral to the day-to-day operations of a modern hospital as any other department. As radiologists, we are well aware of our critical role in the health care system. That said, quantifying the value that we provide can be challenging.

The Radiology Support, Communication and Alignment Network (R-SCANTM) is a tool that can assist practices in this endeavor and at the same time satisfy the Medicare Merit-based Incentive Program (MIPS) requirement that was put in place by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). By participating in R-SCAN, Radiology Consultants has a unique opportunity to work with emergency departments to improve imaging appropriateness and optimize patient care by consulting appropriate use criteria (AUC) and clinical decision support (CDS).

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Our project will examine the utilization of head CT imaging for patients with minor head trauma in the emergency department by sampling CT utilization prior to and following an educational module on appropriateness of head CT imaging derived from evidence-based guidelines in the ACR Appropriateness Criteria. We hypothesize that by emphasizing a guidelines-based strategy for head CT utilization, the number of unnecessary exams will be reduced – thereby increasing the overall value per scan and decreasing costs to the health system.

Our focus area is one of a large number of potential areas of study available through R-SCAN, and going forward our group hopes to broaden our scope and identify additional areas for quality improvement. Not only can projects such as these fulfill MIPS requirements, but they also facilitate communication and interaction with our clinician referrers that can reinforce the important role radiologists play in the health of our patients.

In the recently released 2019 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS reaffirmed that it will begin requiring referring providers to consult appropriate use criteria prior to ordering advanced medical imaging services. By participating in R-SCAN, we’ll be ahead of the curve – and we, our health systems and our patients will benefit.

  • How are you preparing for Jan. 1, 2020, when the implementation of AUC/CDS for all Medicare advanced diagnostic imaging services takes affect?
  • Are you participating in an R-SCAN project?

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

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Patient-Centered Radiology Requires Facing Patients

DebenedectisThis post was contributed by Carolynn DeBenedectis, MD, a breast imaging specialist and residency program director at UMass Memorial

Sometimes in medicine, radiologists are the first physicians to give a patient a life-changing diagnosis. Recently, I had a patient who came in with a palpable mass in her breast. I was the first physician to tell her this was likely breast cancer and to walk her though all the next steps. I went on to read her breast MRI, discuss the results with her and then perform her MR-guided biopsy. Eventually, I was the person who did her needle localization and sentinel node injection for lumpectomy. It was only later that this patient told me that I — at the most difficult part of her diagnosis, amidst the initial shock and uncertainty — was the physician she had the most contact with and the information I provided made those initial weeks less scary. When you, as a radiologist, are the first physician to help your patient through a life-altering diagnosis, it’s critical to be an effective communicator.

Involving patients and families in their care isn’t only the right thing for radiologists to do, but research has shown that it also improves patient outcomes. Radiologists can and should be available to discuss imaging findings with patients and answer their questions, along with primary care physicians. We can also help coordinate next steps in a care pathway and leverage existing and new technologies to communicate with other physicians and patients. Unfortunately, these critical aspects of patient care are often not addressed in clinical education.

These are just some of the many reasons why, in June, the ACR Patient- and Family-Centered Care (PFCC) Committee on Education launched the new ACR Communication Curriculum for Radiology Residents. This free and interactive resource for residency training programs is customizable and centered on best practices for communications with patients, families and physicians. The curriculum can be incorporated as early as first-year and contains on-demand training modules, patient/doctor simulations, skills assessments and sample case study communication. It also enables residency programs to meet ACGME requirements for resident communication training.

It was an honor to collaborate with my colleagues David Sarkany, MD, and Priscilla Slanetz, MD, and a panel of other experts, to create this much-needed resource for residencies nationwide. It’s our hope that residency programs will leverage this ready-to-use content to provide training that best meets their program’s needs ― training that they may not have otherwise had the resources to provide.

We’ve already heard from several residency program directors and chief residents that this curriculum is making a difference. We hope that you’ll be next ― and we’re here to support you along the way as you prepare future radiologists to add significant value to the care of their patients.

  • How are you training your residents to more effectively engage with patients and families?
  • Have you personally engaged with a patient or their family recently? What difference did your involvement make?
  • For more information and to access the free curriculum, visit acr.org/CommCurriculum.

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

Connecting the Dots: AI’s Impact on Radiology Economics, Quality and Safety

LaurenGoldingMDThis post was contributed by Lauren P. Golding, MD, a radiologist at Triad Radiology Associates in North Carolina and faculty for the 2018 ACR Annual Conference on Quality and Safety

Artificial Intelligence (AI). There’s no question it will have a big impact on radiology. But don’t buy into all the hype that it’s a threat to our profession. More truthfully, it holds tremendous potential to help radiologists deliver more value through better quality, which will both drive down unnecessary costs and enhance our critical contribution to patient care particularly in the big picture of population health.

This fall, I’ll be among the faculty presenting at the 2018 ACR Annual Conference on Quality and Safety in Boston during the session “The Chicken and the Egg: Economics and Improvement.” We’ll dive into the business case for improvement, regulatory imperatives and opportunities with AI, practical strategies for measuring and communicating the value-add of radiology, and the costs of delivering good and poor quality. Earlier in the day, Dr. Andrew Rosenkrantz will walk us through his work on radiologist accountability for costs associated with incidental findings. Registration is now open, and I hope that many of you will join us.

This isn’t the first time we’ve talked about AI’s impact on radiology economics, and it won’t be the last. As my fellow faculty, Dr. Gregory Nicola, pointed out in a post for this blog last month, AI application will further advance our ability to reduce unnecessary care and variance. AI could also improve efficiency in data management and integration, building upon and amplifying the benefits gained from participation in the Radiology Support, Communication and Alignment Network (R-SCAN™) and registries. With shifts in US payment policy from traditional fee-for-service to value-based reimbursement models in the Medicare Quality Payment Program, AI presents opportunities – and challenges – for reimbursement.

The ACR Data Science Institute™ (DSI) is working to assist radiologists, AI algorithm developers and federal agencies by defining use cases, providing validation services and enhancing performance-monitoring capabilities. The DSI co-hosted the Spring 2018 Data Science Summit: Economics of Artificial Intelligence in Healthcare at the Society for Imaging Informatics in Medicine (SIIM) 2018 Annual Meeting in May. And in August, DSI will co-sponsor the National Institute of Biomedical Imaging and Bioengineering (NIBIB)’s free two-day workshop on AI in Medical Imaging; a workshop that was so popular it reached capacity on the same day that NIBIB opened registration.

We don’t practice in silos. Cost, quality and safety are closely tied together. By examining the whole system and strategically engaging in regulatory and payment policy issues in AI, we can leverage AI to deliver better value for patients, radiologists and the healthcare economy. See you in Boston!

  • What are some ways you are adding value to your practice by improving quality and safety? Has it resulted in an increased ability to control costs as well?

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