Imaging 3.0: Radiology Gets a Facelift

Radiology is getting an upgrade. After incorporating and mastering the explosion of technologies that emerged on the market over the past 20 years, many industry leaders say it’s time to take practice and patient care to the next level.

This revamp comes in the form of a new initiative from the American College of Radiology (ACR) called Imaging 3.0. It’s a national campaign to guide practitioners and facilities from being focused on volume-based service to concentrating on value-based practice.

“It’s now time for radiology to build the value into our service,” said Bibb Allen, MD, vice chair of the ACR Board of Chancellors and a practicing radiologist in Birmingham, Ala. “The value on the front end of radiology means being involved in identifying the most appropriate test. It’s the value of managing and helping the patient understand the risk of exposure. It’s all sorts of things.”

Reaching this goal, though, will require radiologists to work more closely with referring physicians and to take on more leadership and consultation responsibilities, he said.

What Is Imaging 3.0?

Launched earlier this year, Imaging 3.0 is a campaign that brings radiologists and their referring physicians together with the cutting-edge technologies that can foster more appropriateness in imaging and improve patient care. It’s also a tool designed to create a paradigm shift within radiology.

“All the incentives are there to keep doing more and more. We’re not giving up on fee-for-service, but we have to prepare our membership for the time when doing more of the same old thing isn’t the way healthcare works,” Allen said. “We have to make policymakers aware of the great things radiology can do beyond interpretation. We can’t just say we’re part of the solution, we have to show it.”

The structure of Imaging 3.0 is actually fairly simple, and it changes the current practice of radiologists having little input into study selection and having to conduct only the scans ordered by referring physicians. Within Imaging 3.0, when referring physicians determine the need for a diagnostic study, they can consult a clinical decision support (CDS) system at the point of care. By entering patient data, physicians get an immediate recommendation for the most appropriate study even before contacting a radiologist. If the best choice is unclear or if referring physicians have questions, however, they can reach out to the radiologist for further guidance.

This system is designed with a single goal in mind - to identify the best study for individual patients at the beginning of their care. That choice sets the trajectory for the patient’s ultimate outcome, said Bob Cooke, vice president for marketing for National Decision Support Company, the manufacturer of the point-of-order CDS system ACRSelect, the ACR’s official conduit for access to appropriateness criteria.

“We believe that selecting the right test has impact throughout the entire care cycle - getting the appropriate result is a great first start,” Cooke said. “Selecting the right imaging procedure can have an impact economically, and can improve the healthcare cycle, and it can potentially reduce the patient length of stay.”

What’s Happening Now?

Although Imaging 3.0 is a hot topic of conversation for many radiology leaders, this practice model is far from being the new standard, Allen said. The pull to practice under the fee-for-service model is still strong enough to dampen the industry’s enthusiasm for this approach.

However, there are things that practices and departments can do to begin the shift toward focusing more on value services, particularly in light healthcare reform’s call to control image utilization.

For example, Allen said, providers should participate in the Physician Quality Reporting System (PQRS), maintain their certification, and participate in the Dose Index Registry. They should also encourage their facilities to implement a CDS that works within the electronic health record (EHR) system. Each measure is a step toward a new patient-centric care model.

“This isn’t a campaign to go say hello to three patients a day, and all will be well,” Allen said. “We want to use the tools that are available to make preemptive strikes - to use the data collected to help radiologists intervene at the point of care, when necessary, to make sure what’s done is the most appropriate and that patients get what they need.”

He also recommended radiologists develop a standardized follow-up program and participate in image-sharing programs so they have access to patient reports.

Ultimately, according to Geraldine McGinty, MD, chair of the ACR Commission on Economics, each of these measures will likely have a direct impact on future radiology reimbursement. And, as image utilization is more tightly controlled, radiologists will need to actively demonstrate and deliver their value to justify those payments.

“Radiologists need to identify other ways to contribute, such as patient consultation and educating referring physicians,” she said. “This is the crux of Imaging 3.0 - to ensure providers continue to receive appropriate reimbursement based on the value they show.”

The Importance of CDS

In many ways the linchpin for the success of Imaging 3.0 and the makeover of radiology’s commodity image is CDS, Allen said. Having it added to PQRS or meaningful use would be an enormous benefit to this initiative’s effort.

Whether it becomes a mandate, giving referring physicians finger-tip access to diagnostic scan guidance at the point of order can save both time and money, said ACRSelect’s Cooke. Presenting appropriateness criteria guidance in an easily consumable electronic format is more efficient than relying on referring physicians to consult paper documents.

“Today’s order entry relies heavily on the ordering physician selecting an exam based on his or her knowledge of the patient’s condition. It’s largely driven by physician understanding of imaging,” he said. “We remove the subjectivity. We use a point-of-order set of structured indicators that can help the ordering physician make the right selection.”

CDS systems, including ACRSelect, work best when they’re embedded within the facility’s EHR, he said. That way, physicians can add specificity to their order by selecting various clinical indicators without exiting the EHR platform. Based on the entered parameters, ACRSelect returns a ranked list of possible imaging studies, based on the ACR Appropriateness Criteria, that will meet provider and patient needs.

So far, facilities using ACRSelect have seen a 10 percent to 12 percent drop in imaging utilization, Cooke said. Demonstrating appropriateness and controlling utilization are indelibly linked, he said, and when used correctly, it’s easier for radiologists to showcase their value.

“The basic issue is that radiologists are the experts in terms of what procedures are appropriate and what their impact will be,” he said. “By enabling this collaboration and guidance with the referring physician, radiologists will be able to make more of an impact on the care cycle and continue to do what they do best.”