Getting to the Next Stage in Value-Based Care

2015-10-09
 

Value-based care from radiology.There’s been a great deal of talk about the role of radiology in value-based care (and likely to be a lot more). But because there’s so much information out there, figuring out where we stand right now can be challenging.

In other words, are we headed in the right direction and, if so, what more should we be doing to get to the next stage in value-based care—the one where no one questions the value of radiology in healthcare.

Here are the top three ways radiology can add value right now.

 

 

  1. Making sure the right study is ordered and that the right protocol with the lowest feasible dose is used when performing the study. Bibb Allen of the Birmingham Radiological Group, points out that a lot of imaging care occurs before the patient gets to the hospital or imaging center. An imaging study begins when an ordering physician has a patient encounter and is considering imaging to help in diagnosis or treatment, he says, adding that 15% to 20% of the time, physicians are unsure about ordering an exam and needs to have a discussion with the radiologist. The radiologist needs to be available to take those calls.
  1. Monitoring radiation dose. Jef Williams, chief operating officer of Ascendian, says if ordering physicians are able to see that a patient is close to reaching a threshold of radiation they’re not comfortable with, they may be able to work with radiologists to find an alternative study type. Both patients and physicians would find tremendous value in reducing or eliminating unnecessary radiation, he says.
  1. Using data to discover trends that improve care. Woojin Kim, assistant professor of radiology at the Perelman School of Medicine at the University of Pennsylvania, says in order to promote value-based care, radiology departments should be using data mining and analytics to evaluate whether or not patient outcomes have changed because of radiologist recommendations. However, he strongly believes those functions should extend beyond radiology systems. He relates that by combining radiology with other findings, Radiology Associates of Canton and hospitalists at Aultman Hospital reduced the average length of stay by three days for inpatients recommended for a CT-guided biopsy.

That data, sliced a different way, is the key to measuring the value of radiology itself and thus measuring radiology’s impact on value-based care. Dr. Richard Duszak, vice chair for health policy and practice in the radiology and imaging department at Emory University School of Medicine, says, it’s “a little bit scary for radiologists right now because we don’t have robust metrics of value in radiology.”

Dr. Zeke Silva, vice chairman of the ACR Commission on Economics, says both the Merit-Based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act (MACRA) can play a role in solving that problem.

Silva reminds us that MIPS is made up of four performance categories: quality, clinical practice improvement activities, Meaningful Use, and resource use. He says that although radiology is well positioned when it comes to the first three, the last item is a sticking point. CMS is now using metrics based on episodes of care, and although radiology is usually involved in care episodes for conditions such as COPD, the radiologist may not be the physician to whom that Medicare beneficiary is attributed.

“The challenge for the ACR and radiology, therefore, is to establish quality resource-use metrics that are specific for imaging and less about the full episode of care,” says Silva. Now that sounds like a clear direction for radiology executives to follow for measuring radiology’s contribution to value-based care.

Learn more about radiology’s role in the transition to value-based care by subscribing to the Medical Imaging Talk Blog.

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