Tips for Increasing Value in Radiology

The elegant simplicity of the general value definition, outcomes relative to costs, masks extraordinary underlying complexity, Richard Abramson, MD, of Vanderbilt-Ingram Cancer Center, said at ACR 2015.

Abramson noted that the definition of value is especially problematic for radiology because it looks at maximizing long-term, down the stream outcomes. Radiology, however, is one link in a long causal chain and radiology’s contribution to long-term outcomes is harder to identify in this extensive chain.

The point is, however, Abramson said, that just because something is hard to measure doesn’t mean it’s not worth measuring, or attempting to measure.

“If ultimately we decide we can’t measure value accurately to the emth decimal place, it probably still makes sense [to think about value] for strategic planning,” he said.

Perspective is also an important component in defining value because value varies depending on the stakeholder.

Abramson argued that existing value models claim that the radiologist’s value comes from interpretive work, but examining the noninterpretive activities, and considering them separately, provides potential opportunities for radiology to increase value.

Abramson outlined several initiatives that practices around the country are focusing on as operational strategies to increase value. A few are listed below:

Exam selection/scheduling: Practices can reach out and partner with referring physicians to create diagnostic algorithms around different patients. Scheduling portals are seeing more traction to simplify the scheduling process for referrers and patients, he said.

Decision support: Decision support isn’t just technology, Abramson said. “The core of decision support is good old-fashioned radiologist consultation, and there is a lot practices can do to enhance their consultative role that doesn’t involve implementing expensive IT solutions.”

Abramson gave the examples of a dedicated radiologist hotline for consultations about appropriateness, or a “doc of the day” pager. He noted that some of the old-fashioned solutions are resurfacing as practices try to demonstrate they are willing to go above and beyond with consultations.

Technical operations: It’s the norm for practices to have scanning protocols, but system operations protocols should be developed as well, Abramson said. Issues like contrast administration and patient safety provide opportunities for standardized protocols and will demonstrate to the health system and other stakeholders that a practice is engaged in appropriate and efficient care for patients.

Workflow management, equipment supply: Practices can standardize low-level, smaller purchases of supplies and then work with the larger health system for larger, big-ticket purchases.

Optimize staff and workflow: Optimizing staff coverage optimizes a practice’s efficiency, but there are also workflow solutions a practice can implement, such as triaging stations, or a process to have all prior exams pulled into PACS.

Teleradiology: Abramson noted the teleradiology controversy, but pointed out that teleradiology coverage is especially beneficial in having off-hour coverage, and showing commitment to having subspecialists available.

Marketing: Practices can demonstrate value by participating in hospital marketing efforts, as well as physician and community outreach. He gave a breast cancer awareness program as an example of a community outreach event.