A program created by Brigham and Women’s Hospital is closing the loop on follow-up imaging recommendations while generating enough revenue to cover labor costs, according to new research.
Up to 15% of radiology reports contain suggestions for additional examinations. Failure to execute such imaging can lead to delayed diagnoses and poor patient outcomes, experts detailed in the Journal of the American College of Radiology. To address this issue, the Boston-based institution created a program called “Addressing Radiology Recommendations Collaboratively.” It includes automated communication to close the loop, an IT tool to track patient progress, and supplemental staff to oversee the initiative.
Khushboo Jhala, MD, MBA, and colleagues recently analyzed the success of the effort, using data spanning 2019 to 2021. They found clear benefit, with the program generating nearly $1 million in revenue, more than enough to cover its expenditures.
“Healthcare [safety net] programs have the potential to improve patient safety and decrease diagnostic errors and risks associated with missed or delayed follow-up care, particularly among at-risk populations. However, funding requirements for these programs may serve as an implementation barrier,” Jhala, with Brigham’s Center for Evidence-Based Imaging, and co-authors concluded. “We have shown that the revenue generated from an IT-enabled quality and safety program supplemented by a [safety net] program facilitating resolution of clinically necessary radiology [recommendations for additional imaging] can fund the required additional…labor resources for a large academic medical center of our size and structure.”
Under the Addressing Radiology Recommendations Collaboratively program, radiologists create a special alert as part of their routine documentation, which is sent to the responsible provider via email or page. If the provider agrees to order the imaging, the notification is then sent to a centralized radiology scheduling team that assists in setting up the exam. After the recommended time interval lapses, the tool automatically queries the database to see whether the exam was completed, with further follow-up if it was not. Meanwhile, Brigham created the safety-net team later in the process to address gaps. Their work includes manually reviewing the electronic health record to see if exams have been performed within or outside the health system, along with contacting providers when alerts are left acknowledged.
For the study, Jhala et al. retrospectively analyzed data spanning October 2019 to September 2021. They estimated that 24% (3,243) of eligible follow-up recommendations (13,670) required involvement from the safety-net team. Altogether, Brigham and Women’s generated more than $6.1 million in revenue from performing recommended follow-up imaging exams, with $980,628 attributed to the program. Net SN-generated revenue per 1 full-time equivalent employee was $349,768, researchers estimated. The greatest proportion of performed exams were cross-sectional modalities such as CT, MRI and PET/CT, which generated higher revenue than other non-cross-sectional ones including X-ray, ultrasound and mammography. They also had shorter recommendation timeframes at 153 days versus 180 days.
Jhala and colleagues cautioned that their revenue estimates may be conservative since the analysis excluded certain exams (such as nuclear medicine) and used the lowest reimbursement values for studies.
“The revenue generated from this safety program—by increasing [recommendations for additional imaging] completion rates for clinically necessary imaging—may help fund the additional labor maintenance costs for a radiology [safety net] team, as well as support other quality and safety initiatives that are increasingly difficult to fund given escalating financial constraints facing most health systems,” the authors wrote in the “take home points” section of the study. “In addition to generating imaging revenue to support additional [safety net] labor resources, a radiology SN team can be used to improve timely performance of clinically necessary [recommendations for additional imaging] and reduce diagnostic errors due to missed and delayed diagnoses,” they added.
Read more, including potential study limitations, at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.