It’s never a comfortable moment when you’re trying to make a point and someone’s response is, “Prove it.” Yet that’s the discussion radiologists have been having lately, and the conversation about the value of their work is ongoing.
Proving value is complex — but certainly not impossible. Radiology data is one aspect of that proof; moving radiologists into a more prominent role is another. “We need to become better doctors—real doctors, if you will — who provide real value to our patients, our referring doctors and our hospitals,” said Dr. David Levin, professor and chairman emeritus of the Department of Radiology at Jefferson Medical College and Thomas Jefferson University Hospital in Philadelphia at RSNA 2014. “We’ve let ourselves become the invisible doctors, and that is something none of us are happy about.”
Levin believes radiologists should take on a more consultative role. He says radiologists should supervise and monitor every advanced imaging exam and bolster their input with guidelines such as American College of Radiology Appropriateness Criteria. “Being a true consulting physician also means giving patients access to results, either verbally or via an electronic portal,” he adds.
Dr. Nikola Strickland of the Imperial College Healthcare NHS Trust in London, agrees. She says it’s vital for radiologists to join multidisciplinary team meetings (MTMs) and make themselves indispensible in their area of expertise. “If your institution doesn’t have an MTM in your specialist area of expertise, initiate one,” she told Psychiatric Times.
Proving value = proving quality
Jefferson Medical’s Levin observes that to prove value, you must prove quality—and that means radiology data. “You can’t just beat your chest and proclaim to the rest of the world that you provide high-quality imaging,” he says. “Everybody says that. So those words don’t mean a damn thing.”
Some believe that metrics from the Physician Quality Reporting System (PQRS) may help the cause. Dr. Richard Duszak, vice chair for health policy and practice at Emory University School of Medicine told Diagnostic Imaging that although many think PQRS metrics are flawed, he views it as a work in progress. Given the work CMS is doing to analyze costs per episode of care, it’s possible that in a few years, it will be able to attribute specific cost measures to radiology, he says.
It’s important to acknowledge the resources needed to develop systems that capture the type of meaningful radiology data needed to show value, Duszak adds. Given that they require clinical input, IT, money, and legal advice to develop (not to mention ongoing maintenance), it’s a tall order to expect health systems to drive their development. Instead, these type of systems require for-profit entities or the role of organizations like the ACR, he says. “These are going to be, in part, under the umbrella of professional societies that have the teams that can put these together in meaningful, useful ways.”
Finally, Duszak points out that things that are easy to measure usually aren’t worth measuring. To move to the next levels, we have to move to more radiology data-driven metrics, he says, adding that although the industry is currently at a disadvantage, “the ones who win come up with creative ways to demonstrate our value.”
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