Radiology: Choose Between Change or Trouble

CHICAGO - “Some folks might think that I’m just a paranoid old guy who feels that the world is coming to an end and we had a great ride…but there are major disruptive changes in health care on the horizon, and unless we understand them and respond, I think, personally, the future of our profession is in jeopardy,” Paul Berger, MD, chairman, Partners in the Imaging Enterprise, and past founder and former chairman of NightHawk Radiology, said at RSNA 2014.

The disruption Berger was referring to specifically is the trend of population health. Population health is an idea with varying definitions that are general and complicated, but a well-accepted definition is from an American Journal of Public Health article proposing it as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”

“Population health turns the economics of the health care system absolutely on its head,” Berger said. “The current system is called a sickness system, when somebody gets sick, we benefit.”

Berger explained that in the world of population health, the health care team is paid a “reasonable” sum of money with which physicians need to do what’s best for that patient, because every resource used comes out of the initial pool of money.

Berger addressed the concern that physicians may withhold care in order to keep more in the pool, but he argued that physicians wouldn’t withhold care because then patients would get more sick and use more resources.[[{"type":"media","view_mode":"media_crop","fid":"30961","attributes":{"alt":"Paul Berger, MD","class":"media-image media-image-right","id":"media_crop_478131258104","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3265","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 212px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Paul Berger, MD","typeof":"foaf:Image"}}]]

“We start focusing on prevention, we start focusing on wellness, when someone gets sick, we want them to get well very, very quickly,” Berger said. “We are incented to improve processes and do the right thing for the patient.”

In general, radiologists tend to fall outside of the box with health care initiatives, population health seems to be no different, but Berger argued that with a current economically unsustainable health care system, radiologists can’t afford to fall to the wayside.

“We’ve got to stop protecting the world as we know it,” Berger said. “It’s changing…and we have to embrace that change and redefine and further define the radiologist’s role in a greater level of integration as a member of the health care team.”

 In a population health model, a component of the payment will be related to radiologists’ value to the system, with value defined as quality or outcomes divided by cost, Berger said. Quality has been a notorious and persistent challenge to measure in radiology.

“We want to avoid bad, we want to avoid catastrophe, but until someone can clearly demonstrate to us what quality is, we aren’t worried about quality, we think we are doing a fine job,” Berger said.

Berger urged that radiology needs clearly defined, meaningful, and measurable metrics. “Quality criteria really depend on who is deciding what quality is that matters,” Berger said.

For example, Berger said, for the referring physician, radiologists’ quality can be measured by how easy it is to schedule appointments, how much collaboration or consulting you are available for, and whether your reports are actionable and helpful in managing the patient. For the patient, quality may mean a rapid diagnosis, assurance that their scan was performed safely, and that they were treated with compassion and with excellent communication skills.

The need for measurable quality metrics in radiology is mandatory, Berger said. “It’s up to us to preserve our turf, so to speak, so that we set those qualities very, very high.”

“We need to re-engineer the delivery of what we do and how we do it to enable value-based care,” he said.

The initiative will require strong, decisive, visionary leaders, who really understand the need for change, Berger said. “This course has to change, this course is going to die if we don’t let it change.”

Berger plead with the RSNA session attendants to be those visionary leaders. “The opportunity [to become radiology leaders] is spectacular,” he said.