Sunday, June 21, 2015

Seeing through the future of radiology

I hope you'll permit me a small degree of self-satisfaction as I look back on the chiefs of service I recruited while CEO of Beth Israel Deaconess Medical Center. It is often in this domain (akin to Presidents appointing Supreme Court Justices) where a CEO can make a contribution that outlasts one's term of office.

One such individual is Jonathan Kruskal, the chief of radiology.  It was Jonny's demonstrated commitment to education and to patient safety and quality that elevated him to the top of the short list of some extraordinary people whose technical skills might have be comparable.  His arrival coincided with the current huge national effort to reduce the number of unnecessary diagnostic images that characterize American medicine.  That, as you can imagine, created a large number of stresses on a department that had previously invested heavily in equipment and staff to carry out more imaging than was sustainable.  He handled those business matters in a thoughtful and professional manner.

Now, Jonny and colleagues have published this article in RSNA Radiographics: " Metrics for Radiologists in the Era of Value-based Health Care Delivery."  It presents an excellent survey of the topic and gives food for thought for people in the radiology profession and to hospital and payer administrators as well.  The abstract follows:

Accelerated by the Patient Protection and Affordable Care Act of 2010, health care delivery in the United States is poised to move from a model that rewards the volume of services provided to one that rewards the value provided by such services. Radiology department operations are currently managed by an array of metrics that assess various departmental missions, but many of these metrics do not measure value. Regulators and other stakeholders also influence what metrics are used to assess medical imaging. Metrics such as the Physician Quality Reporting System are increasingly being linked to financial penalties. In addition, metrics assessing radiology’s contribution to cost or outcomes are currently lacking. In fact, radiology is widely viewed as a contributor to health care costs without an adequate understanding of its contribution to downstream cost savings or improvement in patient outcomes. The new value-based system of health care delivery and reimbursement will measure a provider’s contribution to reducing costs and improving patient outcomes with the intention of making reimbursement commensurate with adherence to these metrics. The authors describe existing metrics and their application to the practice of radiology, discuss the so-called value equation, and suggest possible metrics that will be useful for demonstrating the value of radiologists’ services to their patients.


Bob said...

Looks great, and what everyone should be doing. But the word "reimbursement" is something to think about. Instead say "payment." "Reimbursement" is from the old days when patients paid and were reimbursed by the insurance company for the money they paid. This doesn't happen anymore.

Looked at this way, using the word "reimbursement" is an interesting cultural artefact.

nonlocal MD said...

The fact is that the medical specialties of radiology, pathology and anesthesia, perhaps among others, are in danger of disappearing as a combination of factors makes it possible to outsource or commoditize the care provided by these specialties. The 'value' they provide as physicians had better exceed merely monetary value to reverse this trend.