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Knowing what will impact image volumes can help put practices on the fastest road to imaging stability.
As imaging volumes begin to rebound nationwide, not every practice or department will experience recovery in the same way and on the same timeline. But, according to some industry leaders, the same set of factors will play into the imaging recovery across the board, and providers should be familiar with what those influences will be.
Radiologists at Stanford University School of Medicine, who saw a 46-percent decline in their imaging volumes after the stay-at-home order was announced in mid-March, began steadily re-introducing imaging services nearly a month ago. During that time, the team, led by David Larson, M.D., associate professor of pediatric radiology, identified several variables that can directly impact a facility’s imaging volume recovery.
They shared their findings in a June 1 Journal of the American College of Radiology article.
“An understanding of likely imaging volumes in coming weeks and months is important for radiology practices’ planning efforts since…sustained volume decreases could lead to delay in care for patients and substantial financial losses for practices,” the team wrote. “Prediction of imaging volumes may also help practices make accommodations for inefficiencies of practices, including infection control and social distancing efforts.”
Overall, the team outlined six factors that will directly touch both the speed and volume of imaging recovery. The experience of each department or practice will be different, depending upon their individual, localized situation, but all will be impacted in some way by these forces.
While COVID-19 is a national pandemic, some geographic areas have experienced a higher incidence of the virus than others. The level of disease determined how much imaging services were curtailed, and it will also direct recovery as the industry pivots to being post-COVID-19, the team said.
More significantly impacted locations will have deeper drops in imaging, and the path back to normalcy will take longer. If a second wave of the virus occurs, they said, practices will be better prepared to implement COVID-19 protocols even if the imaging volume changes are similar.
Lifting Social Distancing Restrictions
How quickly an area eases its social distancing restrictions will also directly determine how rapidly imaging levels rebound. Areas with slower restriction lifting have a longer recovery time. But, locations where social distancing restrictions are lifted in a phased way can still have a steady rebound is medical care is considered an essential service, they said.
Even if social distancing restrictions are lifted, patients can still stymy imaging recovery if they are too scared to come to the facility, the researchers said. Fearful patients are less likely to venture out for a diagnostic exam, but it is possible to re-engage patients and encourage them to return for services.
“Achieving pre-pandemic levels of patient confidence in safety may take time and repeated interactions with the public and with patients,” they said. “Our medical center’s strategy is to combine a public information campaign with general messages to patients and specific scripting when scheduling exams.”
Managing the Imaging Backlog
How long and how badly an area has struggled with the virus has a direct effect on the volume of postponed imaging with less impacted practices having fewer studies waiting in the wings. Those groups might experience an initial bump in workflow, but they will more quickly return to a typical caseload.
Recovering imaging volume will be harder for more heavily impacted practices, investigators said, particularly if they now have less personnel, fewer resources, and lingering social distancing requirements.
The economic crunch and loss of jobs can keep patients away, as well. With 25 percent of the country unemployed, many people have lost their insurance and cannot afford to pay for diagnostic imaging services. To help radiology groups continue to provide services to patients whenever possible, the Centers for Medicare & Medicaid Services (CMS) granted groups the discretion to waive or relax pre-authorization requirements. The American College of Radiology encouraged private insurers to take the same step.
Practice model differences will also impact group imaging volume recovery, the researchers explained. Much will depend on the types of studies offered and their referral patterns with practices that have fewer elective exams have a faster return to baseline.
It can be difficult, they added, for practices with low volumes to find the right balance between needing to reduce staff to maintain financial viability and needing enough personnel to effectively process the backlog of delayed images.
“Excessive reductions in staffing could have the potential side effect of limiting imaging capacity to accommodate a possible subsequent surge in imaging volumes,” they said, “further exacerbating financial losses.”
Ultimately, the team said, regardless of location or practice type, providers can benefit from recognizing and considering thes factors as the industry begins to enter the initial stages of the post-COVID-19 environment.
“By focusing on key variables specific to local regions and institutions that will likely impact imaging volumes, radiology practices can better prepare to provide safe and effective care in subsequent phases of the pandemic,” they wrote. “We encourage radiology practice leaders to work collaboratively with local health system and governmental leaders to help ensure that needed patient care is restored as quickly as the environment will safely permit.”