Making changes in radiology can happen one step -- and one provider -- at a time.
My kids are always pointing out things society could do better or that would be cool to have. They say we should have flying cars or use recycling to fuel engines or make robots that will clean our rooms. They usually tell me, then, that it’s too bad they can’t do these things all by themselves. My response is that they are exactly who can do this themselves.
An old adage is that you change the world one step at a time and that you have to be the change you want to see. I realize I face this every time I shake my head when someone orders something inappropriate as a radiology test. Sure, there are factors outside our control like patients who demand tests of our referring MDs or referring offices that ask not to have orders amended or questioned. But even these factors can be slowly changed or improved. So here’s how you might do it.
- Consider adding ACR appropriateness criteria scores to our reports. This would be a big change for us and referring providers. The data is out there but not everyone wants to see it or they may feel like their ordering practices are being critiqued. The good news is that if you do it, especially if the ACR were to recommend it officially, you can justifiably explain that it is just inclusion of standards and not a criticism. It’s only an effort at helping the system work better. Change is never easy, but over time people adapt to it.
- Be aware of the landscape. Have you read through the Choosing Wisely? Many referring doctors have and so have patients. We need to be educated on this and similar advice from the medical community. It advises on use of imaging for back pain and in osteoporosis screening. The site is becoming increasingly popular and concepts like this will be growing. You need to be out ahead of them.
- Behind the scenes, you can offer to work with insurers on appropriate use. This has been in place for years, and insurers make recommendations and approvals with some criteria, but many MDs don’t want to work with whom they see as the enemy. Ultimately, we are all working toward at least one goal: cost-effective medicine. So, consider offering your services to help in the process.
- Consult willingly with referring MD offices, and talk to all levels of providers. Let the practices you work with know you are available to consult and, then, be happy to do so.
- Create quick reference guides with appropriateness guidelines for your office staff in your centers. They can provide quick guides when staff call from referring offices to make sure the right test is ordered.
- Make recommendations for follow-up and additional imaging clear in your reports. One critique universally held by referring MDs is hedging or being unclear as to follow-up. Most want us to tell them exactly how to do it and what to order, so don't hesitate. Once in a while you’ll get someone who doesn’t want your advice, but that shouldn't stop you. One other benefit is that your advice is there for the patient to see, as well as any other providers they visit.
- Have your practice create newsletters, blogs, or other media that cover common topics (focus on misunderstood or misused ones) or new updates in radiological problem solving or ordering. It’s a good way to add value and help educate about what tests to order.
As long as you are emphasizing better patient care, you are doing your patients, referring doctors, and the health system a big favor when you help make improved and cost-effective choices.