Physicians value medical imaging. In fact, about 9 in 10 primary care physicians who responded to a survey about imaging’s value reported that advanced imaging improves their diagnostic confidence and provides data that would otherwise be unavailable.
Healthcare executives, on the other hand, may approach medical imaging from a more fiscal perspective. Imaging has been identified as the most rapidly growing contributor to rising costs that is under physician control. Unnecessary medical imaging is estimated to cost the U.S. up to $12 billion every year.
As a thought leader in radiology, RSNA President Dr. Ronald L. Arenson says that radiologists must work to demonstrate the true value of enterprise medical imaging. In this Q&A, he discusses how radiologists can adopt consultative roles, increase patient interactions and demonstrate the value of imaging.
Q: What steps do you recommend health executives take to identify the true value of enterprise medical imaging?
A: The imaging community, including equipment manufacturers and radiologists, has not been very aggressive in proving effectiveness of many of the imaging procedures we use. But it is often difficult to show the actual impact on patient outcomes due to a single imaging procedure when patients often undergo many tests and treatments. On the other hand, the value of many imaging procedures is obvious to physicians and they would argue vehemently against any controlled studies that would randomly deny imaging procedures to their patients.
Having said that, we need more studies of technology assessment and utilization to prove to health executives some information about value. The most straightforward approach might be to simply establish panels of physicians to discuss which imaging procedures as well as other tests are best for particular patients’ conditions. This process should be ongoing, especially for the best implementation of clinical decision support (CDS).
Q: You mentioned in our previous interview that imaging is in the bull’s-eye of healthcare costs. How can radiologists guide colleagues when it comes to imaging appropriateness?
A: In addition to the consultative role mentioned in the next question, radiologists need to embrace CDS for order entry by referring physicians. This automated process has now been mandated by Congress and needs to be implemented by 2018 if radiologists and hospitals expect to continue to be reimbursed for Medicare patients. These systems utilize the appropriateness criteria from the American College of Radiology but many of these rules have been shown to be inadequate by a recent study by the Centers for Medicare & Medicaid Services. Radiologists need to modify many of these rules in order to utilize these systems effectively.
Q: As radiologists transition to undertaking more of a consultative role, is there anything else they should do to help control costs?
A: In addition to the CDS systems mentioned above, radiologists need to be willing and able to consult more with referring physicians. This will be necessary when the ordering physician does not agree with the CDS recommendation but also to guide care for complicated patients, such as sick inpatients. These CDS systems should not only help ensure the appropriate study is ordered, but also help reduce costs by eliminating unnecessary procedures. The experience at both Brigham and Women’s Hospital and Massachusetts General Hospital demonstrated savings.
Q: What investments in technology do you see providing the best ROI when it comes to imaging?
A: Right now the best investments involve Magnetic Resonance Imaging (MRI). The MRI scanners are continuing to prove great value in an ever-expanding array of patient conditions. And the best MRI systems are higher field strength, 3 Tesla, magnets. Ultrasound continues to be a less expensive modality with great applications both for diagnosis and for guiding procedures. Ultrasound is now being used more and more by physicians beyond radiologists especially for procedure guidance.
The other area for consideration by health executives is to utilize less expensive versions of CT, MRI, and Positron Emission Tomography (PET) scanners. Most institutions and radiologists prefer systems with lots of features but these added features often drive the purchase price up considerably. However, the right balance of cost and functionality is not easy to achieve.
Q: Anything else you’d like to add?
A: Two other themes to note are the role of radiology in precision medicine or personalized medicine and patient-centric care. Precision medicine is going to be a game-changer in healthcare in the next decade and could be profoundly improved by the proper imaging. These analyses of genetic markers or genetic expression require nuclear imaging such at PET/CT as well as advanced MRI such as spectroscopy.
Patient-centric care in radiology will require much more interaction between radiologists and their patients. That interaction occurs already in interventional radiology but needs to spread to the rest of diagnostic radiology whereby radiologists will interview patients and discuss findings before they leave the imaging suite.
Read further insights from Dr. Arenson regarding how radiology departments can adapt to complex changes in healthcare in our earlier interview, Q&A with New RSNA President Ronald L. Arenson, M.D.