Value-based care nothing new for women’s imaging

The move toward value-based care is one of radiology’s most talked-about topics, but according to a recent editorial in the American Journal of Roentgenology, it’s just another day in the office for women’s imaging.  

Marcia C. Javitt, MD, director of medical imaging for the Rambam Healthcare Campus in Haïfa, Israel, is the AJR’s section editor for women’s imaging. She explained in her editorial that healthcare focused on value over volume is familiar territory for those in women’s imaging.

“Breast imaging has lived in the world of value-driven health care for more than a decade, though the truth is that the initiation of breast imaging into this world was not voluntary,” Javitt wrote.

Javitt detailed how the Mammography Quality Standards Act (MQSA) was enacted in 1992, eventually leading to regulations that went into effect in 1999. The legislation was effective, she said, and violations at mammography facilities were down significantly in just a few years.

The CMS deadline for all advanced imaging to be ordered through clinical decision support based on appropriate use criteria was recently delayed, but value-driven healthcare is still coming to the entire imaging community. What does this mean for physicians? For the healthcare industry as a whole? Nobody knows for sure, but Javitt shared a few predictions.

“Given the new emphasis that will be placed on integrated multispecialty medical care, radiology will almost certainly transition from a profit to a cost center,” Javitt wrote. “How this will affect radiology and, specifically, women's imaging is uncertain. The profit margin in mammography is so narrow already that the effect may be limited. It is more likely that the downstream revenue from breast interventions or surgery will be more dramatically affected.”

Javitt did note one impact value-driven healthcare has had on women’s imaging: physicians from that field of study are among the very best in “evidence-based image interpretation, transparency, and accountability.”

“MQSA requirements include follow-up of positive mammographic findings, tracking pathology results for all biopsies, and radiologic-pathologic correlation,” Javitt wrote. “Outcomes audit data are tabulated for each individual interpreting physician and in the aggregate at mammography facilities at least once every 12 months. Computerized tracking is typically used to calculate the data required for MQSA audits. Sensitivity, specificity, recall rate, positive predictive value level 2 (based on recommendation for tissue diagnosis), and cancer detection rate are included at minimum.”

Another change Javitt has noticed is the way performance is measured.

“Performance indicators used to gauge value include study appropriateness, time to final report, timeliness of reporting critical findings, equipment utilization, radiation exposure to individuals and populations, prevalence of contrast-induced nephropathy, ease of access to care, waiting time for appointments and service, peer review, patient mortality, length of hospital stay, time to diagnosis, medical errors, and complication rates,” Javitt wrote. “The entirety of the patient experience will be scrutinized. The patient's perspective on appropriateness and desirability of a study, comfort and customer service, quality of care, and expertise of the interpreting physician is more important than ever before.”

Javitt noted that a large amount of the latest edition of AJR is focused on women’s imaging and its place in this “brave new world.”

“Imaging is essential, but now it is inextricably linked to evidence-based medicine, which in turn will be linked to reimbursement,” Javitt wrote. “It is no surprise that women's imagers are nodding their heads and saying ‘Welcome to the Club!’”