Radiology leaders advocate standards-based medical imaging programs to reduce errors and improve efficiencies. The aim is to reward radiologists "not for more procedures, but for the right ones."
"[Radiology is] the greatest profession in medicine. When a patient comes to you, if you are not sure of the answer, you simply just order more tests," says Everett Neal, And "by the way, you get paid for that," he laughs.
Neal, the VP of Hospital Partnerships of Radisphere, is relating what he terms a "cynical" view that some people have about radiologists.
Joking or not, he touches on a truism that has often been pinned on radiology: It's too costly, there are too many procedures, and it's a microcosm of the woes of healthcare itself.
Yet many healthcare leaders are trying to change that; Neal among them. So is Allen Weiss, MD, president and CEO, NCH Healthcare System in Naples, FL, which is coordinating radiology care with a focus on efficiency and standardization.
The approach is team-based, and technology-driven, with the intent of improving procedures, while reducing errors and overutilization, Weiss says. Weiss and Neal spoke last month at a HealthLeaders Media webcast, New Radiology Standards to Reduce Costs, Increase Quality and Improve Outcomes.
Several years ago NCH changed its radiology program to improve data collection and quality enhancements through a partnership with Radisphere. Before that move, "we literally didn't have any quality parameters, not at all," Weiss recalls.
Now, radiologists are "getting rewarded not for more procedures, but for the right ones…We're ordering fewer procedures and [fewer] tests," he says.
OK, but is it working? "Reimbursements are going down dramatically," Weiss confirms.
As Weiss and Neal see it, radiology has become a forgotten "outlier" in discussions about reducing healthcare costs and improving quality of care. A Radisphere study found radiology "lags substantially behind" other health care practices for improved quality standards.
While many call the healthcare industry fragmented, radiology is especially so, they say. There are more than 25,000 radiologists in private practice there are at least 2,000 radiology groups.
Yet radiology has great potential. The Advisory Board estimates that radiology will grow at a 9% rate annually, and high tech imaging will grow faster, at an 18% rate, according to Radisphere. Radiology represents nearly 10% of U.S. commercial healthcare spending each year, equating to more than $200 billion in annual spending.
As systems move toward population health, radiology will play an increasingly important role, Everett says. "It has a tremendous impact on the metrics everyone cares about, including: 'Are we radiating folks with too much radiation? How do we get costs under control?'"
"We've got to get radiologists out of the basement" onto the "care floor" of hospitals, such as having radiologists consult regularly with other physicians and patients, "making sure the right tests are being performed," says Neal.
Indeed, Weiss and Neal say there have been too many errors, too much clinical variation, and too much costly duplication of work among radiologists. They say it's important that providers and hospitals adopt system level standards and best practices for radiologists to improve efficiency and quality.
By establishing measurable performance standards to evaluate and ensure accountability among providers, radiology programs can be markedly improved, according to Weiss and Neal. There are tough tasks to overcome. Lack of coordination to improve workflow and costly turnaround times impact the complete care cycle, especially the emergency departments.
Through these standards-based approaches, hospital officials can reduce overutilization. Radisphere estimates that studies show about 20 to 50% of inpatient diagnostic imaging may be clinically unnecessary, driven by referring physicians and radiologists.
Unnecessary imaging can occur when "a wrong exam is being ordered to begin with, or a radiologist can't get a 'clean' read, Neal says. "There is a big variation that frequently has tremendous downstream implications" for costs and quality, he says.
Eliminating radiology errors also is a major concern among hospital officials. The error rate in procedures can range from 4.4% to 9.2%, according to Radisphere.
Error rates have a significant impact on downstream healthcare costs that will gain urgency under healthcare reform and new delivery models, Weiss says. By implementing the standards-based programs, the hospital has reduced errors, he adds. And the healthcare system has established peer review programs to ensure that radiologists are accountable for their work.
NCE did an extensive review of its radiology programs, looking for significant discrepancies and potential errors. In an evaluation of 47,000 cases, officials found discrepancies in 40 cases, a .08% rate, Weiss says.
"We'd like it to be zero, but stuff is going to happen. But .08% is still reasonable." When any problems are identified, Weiss notes, "Results have been communicated back to the referral physician by the reading radiologist to ensure the communication loop has been closed."
"You need standards," Neal says of radiology programs. "Most [healthcare leaders] will pause and say, 'I have standards." But when Neal says he talks to healthcare leaders about standards, he finds many hospitals lack efficiency clauses in contracts with radiology groups.
"You need to write it down and say what you need from radiology. You have to say what your objectives are."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
