Americans receive twice as many MRIs and CT tests — 100 and 265 each year respectively for every 1,000 people — than the average in other countries that are members of the Organization for Economic Cooperation and Development. But extra tests aren’t benefiting patients. Despite spending 18 percent of the U.S. Gross Domestic Product on healthcare, Americans have shorter life spans than citizens of our peer countries.
Individual radiologists may feel like reducing the number of studies their healthcare organization undertakes is beyond their power — how can one practitioner make a difference? There are concrete ways that radiologists and leaders can collaborate to make a difference by working toward value-based care in medical imaging.
“It is critical for radiologists to be heard,” says Rasu B. Shrestha, MD, MBA. “They need to speak up, they need to participate in committees, they need to engage in the care of their patients, and in the design of the healthcare system that is about the patient in the center of the care collaborative.”
Here are three ways that healthcare leadership and radiologists can use value-based care strategies to influence change.
Educate referring physicians. Physicians want to give their patients the highest quality of care and ease their suffering. Radiologists can work with healthcare leaders about ways to have helpful conversations — without blame or criticism — about alternatives that referring physicians can offer patients who are asking for certain testing that may not be appropriate.
For example, a patient who has severe headaches may persist in wanting an MRI or CT scan, which is used to rule out a life-threatening problem such as a brain tumor or aneurysm. However, only a tiny percentage of headaches are caused by something that can be detected by a medical imaging test. Unless a patient has risk factors or symptoms that indicate a possible tumor or stroke, testing is not appropriate, according to guidelines set by the American College of Radiology. Instead, physicians may offer patients ways to manage their headache pain per recommended guidelines.
Follow evidence-based guidelines. According to a study that analyzed evidence-based guidelines for CT and MRI tests, between 26 and 30 percent of the imaging tests were deemed unnecessary or inappropriate. That equates to a cost of $200 billion a year.
One tool that healthcare providers can use to support their efforts to implement value-based care is clinical decision support (CDS). Medical imaging decision support contained within physician workflow gives providers objective guidance about testing. CDS analyzes characteristics of individual patients and makes recommendations to caregivers about what testing is proper for the right person and when, helping to reduce rates of unnecessary testing.
“Radiologists are best able to set the right decision support rules in place with the right availability of appropriate clinical data, based on evidence based guidelines and the patient’s presenting symptoms,” says Shrestha. “This, if done well, ensures that the patient ends up with the most appropriate imaging test (if one is warranted) and this not just is in the best interests of the quality of patient care, but also saves the system money!”
Analyze gaps and redundancies. Radiologists have a critical role as part of the integrated healthcare team. Over a full cycle of care, from prevention through treatment and management, any redundant testing or inconsistencies that veer away from best practices should be pinpointed and changed.
Radiology department supervisors have an important role to play here as well. They should take a step back and ensure that their team isn’t simply following the usual routine that has “always been done this way.” Instead, value-based care entails ensuring that tasks aren’t redundant, filling in gaps to help promote care that is determined by clinical quality, and providing necessary care for patients.
“The conversation needs to start with what is in the best interests of our patients, and end with tangible methodologies to optimize costs through the system,” says Shrestha. “Radiologists need to work hand in hand with leaders from IT, finance, administration, operations and the payers to really transform imaging to where it needs to be.”
By the time radiologists provide care, they may feel as though it’s too late to make any changes to ensure that value-based care strategies are being followed. However, they can work alongside healthcare leaders to pinpoint areas where they can offer valuable input and feedback to the entire healthcare team, including referring physicians.
“Radiologists need to control their own destiny,” says Shrestha. “There is much talk in the industry today about how radiologists are being commoditized. But I ask, what then is the solution to this problem? They are not mere diagnosticians who sit in a dark corner of a hospital churning out reports all day long – they are, first and foremost, clinicians. They are healers. They are physician consultants that need to ensure that their true value is seen, heard and felt across the system right to the patient level.”
Radiologists are being urged to view and affirm themselves as critical members of the care team who have valuable voices to be heard on implementing value-based care strategies to benefit both healthcare organizations and patients.
Learn more about value-based care in radiology by downloading our e-book, The Evolving Enterprise Imaging Market.