Radiologists Feel Need to Speak Up About Value They Bring to Oncology

James Rawson, MD

Though they often lend strength to oncology practices by combining through mergers and affiliations, radiologists are feeling pressure to demonstrate the importance of their work, as the value transition brings increasing scrutiny to levels of waste, inaccuracy, utility, and technological sophistication in their trade.

Speakers planning to present at the upcoming American College of Radiology (ACR) conference in Washington, DC, May 15-19, said that the value transition is leaving no stone unturned.

The value transition is reaching into large medical institutions as well as smaller, independent practices, said James Rawson, MD, a diagnostic radiologist and chair of ACR’s Commission on Patient- and Family-Centered Care, who practices at the Medical College of Georgia at Augusta University, where he serves as department chair for radiology. It’s important for radiologists to reassess their activities to more clearly define and enhance the value they contribute to the medical process, he said.

“That value could be improved outcomes, it could be lower cost, it could be better patient experience; but, our challenge is to figure out how to increase and improve the value. I think, like everybody else, we’re in the middle of this,” Rawson said.

Radiologists have a vital role in the medical establishment, and, in some cases, they are more upto- date in their use of technology than other medical personnel, Rawson said. “In radiology we have been using computerized information systems for decades, and so we’re not on version 1.0 of radiology information systems or version 1.0 of PACS. I think we bring a unique perspective as we enter into an era of population health and as we look to optimize the care of an entire community.”

Rawson trains radiology residents at the Medical College of Georgia and believes that the broad variety of skills his students are learning—medical physics, clinical radiology, process improvement, informatics, and others—are very much in demand and signify the importance of what radiologists do. “I think we have the skill sets to help optimize system performances, patient outcomes, patient experience, and actually work to lower costs. I think we’re an essential part of the solution,” he said.

Andy DeLaO, chief engagement officer of My Ideal Patient Experience and a Mayo Clinic Center for Innovation healthcare blogger who is delivering the Moreton Lecture at the 2016 ACR conference, said patient expectations are on the rise, as technology has equipped them with far more information about healthcare than before, and their demands for quality are higher, given that more of their own money is being consumed by rising copays and coinsurance.

“I think patients today are knowledgeable and informed and they want to know what they’re getting for the money they’re spending,” DeLaO said. He is a believer that the value change has its roots in the now-highly connected economy that enables patients to obtain good quality healthcare information very rapidly through their electronic devices, leading to levels of discretionary healthcare shopping that did not exist before. “I’m not sure that most people working inside of healthcare would agree with me, but that’s my perception of it,” DeLaO said.

DeLaO said he has had extensive involvement in the development of hospitals and cancer centers, and in renovating and expanding oncology service lines and facilities.

Appropriateness of care was mentioned by both Rawson and DeLaO as an important measure of radiology performance. DeLaO said that satisfying this objective can take the form of quality improvements that include correct interpretations of radiology work the first time around, leading to a decrease in healthcare expenditures. “When a patient comes in, the definitive diagnosis is generated by the radiologist, the pathologist, and that drives the rest of the treatment decision. I think that’s part of the story that needs to be told, and they need to demonstrate that.”

Patients Should Receive More Information About Findings

Integrating successfully with the efforts of other professionals is also key. DeLaO recalled a broad collaborative effort, in which he participated, that led to the achievement of a 72-hour maximum turnaround from patient arrival to an understanding of potential treatment options for that individual. “The only reason that happened was due to our ability to to share the information from radiologists and pathologists with medical oncologists, radiation oncologists, and surgical oncologists and vice versa. This cross-flow of data enabled all physicians to understand that they were running the right tests, at the right time, to satisfy the need for useful data, said DeLaO, who declined to name the healthcare organization involved.Patients need to be shown in other ways that they are getting value from the radiology staff, DeLaO said. One possible way of doing this could be providing a simple sheet of paper to patients following an exam that has the word “radiology” on top and states “this is what we found,” with key issues identified and an invitation to ask questions, DeLaO said. Such an offering also could be made via mobile phone.

Such initiatives can help to bring the work of radiologists into the open, DeLaO said. “For too long, the conversation about the value of what radiologists do has been controlled by the referring physicians, or it has been controlled by the specialists.”

One further step can help to win over patients, DeLaO said, and that is to engineer an in-house cultural transition that boils down to what he calls the “Four T’s”: Time, Trust, Transparency, and Transition. “Radiologists need to understand how you can allot the right amount of time with patients so that you are building the trust, which leads to a transparent conversation, which then helps you to manage transitions in the journey of healthcare.”

Rawson said that there is a great deal of adjustment ahead for his profession. “I think there are good tools being developed to help us make better decisions and better recommendations, and integrate in a more efficient way as part of our dictations and our radiology reports. Those may be challenges, but I think we are up to facing those challenges, and solutions are being developed to do that.