How Value-Based Care is Affecting Radiology

May 2, 2019

The shift to value-based care may be slower than anticipated, but it’s going to drastically change radiology.

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.

In addition to these measures, Ian Weissman, DO, FACR, a radiologist with the Milwaukee Veterans Affairs Medical Center points to two ways the growth of value-based care has impacted patient contact.

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.”

The best way to overcome this stumbling block, he says, is to learn to speak the language of your organization’s leadership. For example, rather than expressing a need for machine learning because it’s state-of-the-art, explain how the technology can improve revenue, workflow, and patient care.

Additionally, Whitfill says, current payment systems that still largely incentivize volume over value are stymying value-based care adoption. Providers who don’t perform well enough under the Quality Payment Program still see their payments drop, but only by a few percentage points. That may not be enough to entice large scale changes in the practice of radiology.

“Until a provider or system has 20 to 30% of their revenue at risk from value-based care, they probably won’t really embrace it,” he says. “Until we see payment models get to that point of penetration-until you hit some magic number-there will probably be some reluctance on the part of physicians and systems to fully adopt it.”

On the flip side, he says, some leading-edge systems are being aggressive, meeting with employers and insurance companies to discuss taking a more forward-thinking role in value-based care. Doing so puts these groups in a leadership position.

What the future could bring

Despite a slower-than-anticipated beginning and less-than-robust adoption, the future for value-based care is certain, Whitfill says. As bundled payments become more common, the opportunities for radiologists to be active care team members who can provide added value will multiply.

The ACR’s Silva agrees that value-based care will continue to take hold as a growing number of specialists begin to embrace it. In many cases, it could allow practices to remain independent as more patients could be attracted to a care model that places high emphasis on providing value. Additionally, it could bolster the growing trend toward national practice models where groups pool their collective resources to provide value-based care on a larger scale.

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Although the future is still slightly unclear, the move toward value-based care has been a paradigm shift that has set radiology back on the right track, Larson says.

“From my perspective, this reorientation to a focus on quality and service is just a correction in a system that had gotten out of balance with too much emphasis on volume. It is about providing a great product to one’s customer-one that’s great from the customer’s perspective, not just ours,” he says. “This increased focus on value is simply the market pressures helping to ensure we are doing our jobs well.”