March Madness in Radiology: the Push for ACOs

The season has brought a different kind of March Madness in healthcare as we see a rush to develop and implement accountable care organizations (ACOs). Often these are being driven by hospitals or health systems, but multispecialty groups are also in the game, and large, single-specialty groups need to be players as well.

Whispers in radiology circles are that ACOs could put a full-court press on hospital based specialties, creating headaches for them.

But ACOs look to me to be critical tools in achieving our goal: to provide ever-more affordable, high quality healthcare quality through reduction of ER visits, reduction of inpatient stays and elimination unnecessary care. Radiology stands to play a critical role in each of those efforts, and must be a critical player in ACO development.

The central elements for ACOs will involve care coordination, increased quality and safety, and creation and application of policy standards. So many radiology tests affect care coordination today. Health systems need to employ practices which prioritize scheduling through clear standards and communication.

Prompt, consistent report delivery must be available and employ current technologic standards that streamline this, including tablet and smartphone delivery to providers. Rigorous quality reviews, peer evaluation and communication between radiologist and technical centers must be used to improve quality. Electronic methods of tracing and evaluating incidents should be employed.

Finally, radiology must engage in and use appropriateness criteria and similar tools wisely. These tools have been present for years but the allegiance to every doctor have their own self determinism seems to hold back their use.

We must be brave enough to communicate internally about such standards with ordering providers both for individual cases and in a general sense to educate. Face-to-face, phone or email discussions about use of such tests are a start. Organized conferences, paper or e-newsletters are another option for discussing common issues.

In short we should be looking to be an active player in fostering the principles behind the ACO concept and not sit at the end of the bench.