New ACR health policy chair lays out agenda

The political heat surrounding diagnostic imaging has gone up several degrees over the last few years. The American College of Radiology's political action committee is now a top financial contributor among healthcare organizations. The college regularly lobbies politicians on Capitol Hill and testifies before Medicare advisory panels regarding imaging issues. Congress responded in the spring by convening a special hearing to examine and possibly revamp imaging credentialing and reimbursement.

Against this background, Dr. Michael J. Pentecost in June assumed leadership of the ACR's Health Policy Institute, based in Washington, DC. He succeeds Dr. N. Reed Dunnick, the initial chair upon the institute's founding in 2003. Pentecost has served as president of the Society of Interventional Radiology and the Society for Health Services Research in Radiology. He is director of Kaiser Permanente radiology practice in the mid-Atlantic states.

The HPI's mission is to conduct research in radiology on public policy, disseminate its findings to targeted audiences, and bring a radiology perspective to health policy deliberations at all levels of government. Diagnostic Imaging asked Pentecost to name his priorities as the new chair of the HPI.

Pentecost: Most people generally divide health policy into four issues: utilization, access, quality, and cost. We will use these same broad categories for our work with the college.

Utilization means using the appropriate resources for the diagnostic or interventional management of patients. We want to ensure we perform the right exam and in a way that is safe and cost-effective.

Quality is the essence of any professional organization's mission. Everyone is entitled to the same high-quality services regardless of the setting or hospital. A major part of this work will involve defining, measuring, and promoting quality and helping people understand quality management and improvement initiatives.

The third issue, access, is important. Radiology is a high-tech specialty, and we want to make sure that patients - regardless of their background - have access to these services.

Cost is one of the real escalators of healthcare spending. That puts great onus on us to ensure we are spending the public's dollars for these resources as wisely as possible.

Diagnostic Imaging: Can you be more specific about how the institute will address these issues?

Pentecost: Utilization is the issue radiologists understand the best from a national as well as a regional and personal perspective. They can see that self-referral is a threat to their own practice as well as to any efforts toward cost control.

To understand this problem, the institute must study people's motivations for referring patients for imaging exams, and it must determine the real root of these reasons. Previous studies done by the college have shown that self-referral - physicians referring patients to imaging laboratories where they have a financial interest - has been a source of overutilization. These studies led to Stark I and II legislation and to the recent designated physician imager initiative by the college.

Without research, which is really the mission of the institute, to supply the underpinnings for that kind of political position, the viewpoint of the ACR would look self-interested. We want to be able to back up what we regard as legitimate concerns with real data from studies.

DI: Collecting data takes time. How do you envision gathering enough to effect change as quickly as possible?

Pentecost: The data do take awhile to collect, but there is no time like now to begin. Modern electronic medical records and data systems do allow data to be queried and accessed faster than in the past.

Quality is another issue we think will separate radiologists and other imagers. We anticipate trying to define and measure quality and its impact on healthcare services in the hospital or outpatient setting.

DI: Quality can sometimes be amorphous. Do you have hard metrics to determine and measure quality?

Pentecost: The hard metrics so far are mostly centered around mammography, such as the number of positive biopsies, stages of disease that a woman presents with, access to services based on populations, and how many people are conforming to the guidelines. That is probably where we'll start.

DI: For what studies do you see radiologists using these quality control metrics?

Pentecost: Certain examinations more than others have a much bigger public health impact, such as colon, lung, and breast cancer. Patients with these diseases are going to come to medical attention first from a radiologist's office. It's incumbent upon us to try to be as precise and accurate as possible in our diagnosis.

Conditions that are rare or have less public health impact would be less fruitful areas for the institute to study. We will concentrate much of our time in cancer imaging because that is where the future is going and what radiologists have excelled at in the last couple of decades.

DI: Who else will be a part of the institute?

Pentecost: We anticipate having half a dozen staff people as lead managers or scientists in the group. We'll need to attract funding before we can go any further than that. The steering committee, still in formation, will consist of a broad cross-section of people from private and academic communities that have an interest in these issues.

DI: How are the various areas of research coordinated?

Pentecost: Research activities at the institute are concentrated in a number of centers:

• Patterns of Care Study. Assess screening mammography, diagnostic mammography, treatment and post-treatment, and variability in care in Pennsylvania.

• Center for Health Systems Studies in Radiology. Investigate health systems issues that directly affect radiologists, for example the employment market for radiologists.

• Center for Quality Initiatives. Study the impact of accreditation, standards, and appropriateness criteria, error rates versus experience, and turnaround times and impact on care.

• Center for Health Policy Studies. Research topics include Medicare physician payment, utilization of services by Medicare beneficiaries, use of radiology services by persons without health insurance, impact of the malpractice crisis on radiologists, and patients' access to radiology services.

• FORUM. An ACR think tank modeled on the RAND Corporation.

For more information from the Diagnostic Imaging archives:

ACR calls report on skyrocketing imaging distorted

Panel builds case for new self-referral limits

Radiologists and cardiologists square off before Congress

Federal imaging proposals mesh with ACR initiatives