Value-based care is a term that’s been bandied about in radiology for more than a decade. It’s been a buzzword for several years and has been both the impetus and goal of many federal legislative actions.
But, through the Physician Quality Reporting Initiative, the Medical Access and CHIP Reauthorization Act, and Protecting Access to Medicare Act, the concept hasn’t gained as much traction as initially anticipated, industry leaders say.
“Value-based care is evolving quickly, but it’s evolving slower than some of us might have predicted two or three years ago,” says Ezequiel Silva, MD, FACR, chair of the American College of Radiology Commission on Economics.
In 2015, then-Secretary of Health and Human Services Sylvia Burwell postulated in the New England Journal of Medicine that 50% of Medicare payments would be tied to value through alternative payment models as of 2018. That level hasn’t yet come to fruition, but the industry continues to incrementally move toward a wider embrace of value-based care.
And, in many ways, this push for a greater focus on value has already changed how radiologists practice on a daily basis.
Changes in practice
Many of the conversations around value-based care center on how the shift away from volume in radiology will affect your reimbursement. But, this pivot toward value involves more than changes to your bottom line. It’s also impacting how you run and organize your practice, says David Larson, MD, associate professor of pediatric radiology at Stanford University Medical Center.
In a study published last year in Radiology, Larson and his colleague Jonathan Kruskal, PhD, MD from Beth Israel Deaconess Medical Center outlined several steps radiologists are taking to succeed within the value-based care environment. Implementing these strategies, he says, can strengthen your focus on value:
- Know your customers: Talk with your main customers—your referring physicians—about their needs and how they’d like to see your performance change or improve. Devise ways to meet those goals.
- Embrace the physician role: Join hospital boards and committees, and make yourself available for conversations. Giving positive responses to feedback can also be helpful.
- Communicate: Produce reports that reflect national guidelines and are free of any typographical mistakes. Also, be willing to call a referring provider to directly discuss a patient’s care. “We must re-design our processes of communication to be more user-friendly to our referring clinicians,” Larson says. “It’s about monitoring our own internal quality and constantly improving it, developing true teamwork, collaboration, and collegiality.”
- Pursue teamwork: Build trusting relationships with your referring providers to ensure your patients receive care in the best environment possible.
- Constantly learn: Be willing to learn from your colleagues and impart your knowledge freely. Be open to adapting your procedures.
- Use resources wisely: Knowing what not to do is critical to providing value. Avoid unnecessary repeat imaging, inappropriate recommendations, non-diagnostic studies, procedure complications, negative consumer experiences, adverse safety events, slow turnaround time, and incorrect or vague interpretations.
- Be thoughtful: Consider critically about whether you’re thinking outside the box about the best ways to improve your performance.
- Make excelling easier: Work with your IT department to put the right processes and systems in place to make it simple to read, write, share, and save your reports.
First, he started a habit he calls “Hello Rounds” where he makes a point to speak to every patient he sees in the hallway and ask them if they need anything to be more comfortable.
“I feel like I’m more engaged with the whole patient experience, and it actually improves my day because I’m able to interact with people,” he says. “I really enjoy that. It’s something that can be done very easily in practices.”
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Alongside speaking to patients, he says, some providers now attach their phone numbers to reports so patients can reach them directly with questions.
The push toward value-based care has also led to the rise of more clear recommendations being included in reports to reduce the use of inappropriate testing on follow-up exams, says James Whitfill, MD, chair of the Society for Imaging Informatics in Medicine board of directors. On the ordering side, the implementation of appropriate use criteria has added a value component to the radiology ordering process to ensure that the right exam is performed for the clinical situation.
Challenges to embracing value-based care
Overall, the biggest impediment to investing in and implementing a value-based approach to care in radiology is an organization’s culture, Weissman says.
“One of the biggest challenges I’ve identified has been the culture of the organization,” he says. “If the culture of an organization does not support value-based care, then they’re not going to adopt it.”