There’s a Patient in the House

Radiology must put the patient at the center of its universe or join the race to the bottom of the reimbursement barrel

If there is one thing that should keep radiologists up at night, it’s the issue of patient-centered radiology. Referring physicians have always been at the center of the radiological universe, and that is not an orientation that will serve you in the new healthcare order.

Make no mistake—this is not optional. Patient centricity is the central tenet of the Affordable Care Act, likely intended to protect patients from the abuses of 1990s-style managed care.  Because of that, patient satisfaction scores are a factor in hospital—and physician—reimbursement; accountable care organizations are required to have patient representation on their governing boards; and patients are ensured respect, recognition and choice in all matters and relationships pertaining to their health.

Besides, your financial health is at stake. The value-based payment train is gathering steam, and it’s headed straight toward the measurement of patient outcomes. If radiology can’t put the patient in the picture then it will join a race to the bottom when it comes to reimbursement. 

How radiology will make this transition will test the specialty in the months and years ahead. Few radiologists see patients, and those patients who are seen by a radiologist are likely to be in the throes of a healthcare crisis and not overly interested in developing a relationship with the man or woman, masked or unmasked, delivering therapy or performing a biopsy.

For the rest of the radiologists out there, if you are introducing yourself to a patient, you are probably also keeping one waiting for their results. For that reason, patient-centered radiology will look somewhat different in diagnostic radiology than it will in other specialties.

Make lemonade

Rather than dwell on the obvious challenges to a patient-centered practice, radiology would be better served by using the very tool that has distanced it from its customers: information technology. Radiology needs to turn that lemon into lemonade by leveraging its IT expertise.

Radiologists and radiology vendors have excelled at using information technology to enhance intra- and inter-departmental communications. Why not do the same for patients? Deputize your patients in their healthcare by giving them their results in a form that they can understand. An informed patient is a healthier patient.

Hospitals are having difficulty with this aspect of meaningful use attestation. In fact, former National Coordinator for Health Information Technology, Farzad Mostashari, MD, confirmed for attendees at the 2015 HIMSS annual meeting that providers are side- stepping the requirement.

Two thirds of all organizations that have successfully attested to stage 2 meaningful use IT have circumvented the view/download/transmit requirement by invoking the exception granted to organizations that claim not one patient has asked for digital access to their records. Maybe not one patient asked for his or her records, but I don’t believe that not one of them would have liked to receive health records electronically. What do you think?

You can help your hospitals attest to the meaningful use of health IT by making it easy for patients to access images and reports. Don’t stop there, though: Give your patients an easy way to communicate with you directly through email or a dedicated phone line. 

Over the years, many leaders in radiology have urged their fellow practitioners to get out of the reading room and meet one patient per day. A concerted effort to open digital communications could go even further by educating more patients about the role of radiology in their care and it could happen without disrupting the workflow of the radiologist.

Direct patient contact is a worthwhile mission, but it is not as important that patients know who you are as it is that you know who they are. Here, again, information technology could be a critical enabler.

Imagine the department as a hive of information generated by imaging modalities and radiologist reports and flowing in from all over the healthcare enterprise—laboratory, pathology, physician notes. In true patient-centered radiology, the radiologist has more information about the patient than possibly any other physician in the enterprise.

Of course, such a future will require radiologists to make some changes and the radiology department to acquire new tools and assume new responsibilities. Following up on significant incidental findings is a great place to begin. For this to happen in a meaningful way, radiologists must finally let go of their beloved prose reports, take the necessary steps to structure their data and produce structured reports.

Call me a fangirl, but I submit that there may be more answers to patient-centered care in the radiology department than anywhere else in the enterprise. Stay tuned as we dig into patient-centered radiology from the operational, clinical and communications perspectives in the next issue of Radiology Business Journal.

Cheryl Proval
cproval@imagingbiz.com