Nonphysician Providers and Patient-Centered Radiology

June 2, 2016

Radiology practices look to nonphysician providers to increase value.

“If we only adhere to a volume-driven culture, we are lost,” – said Heather Molina, PA, Northwestern Medicine

Heather Molina understands the pressure to deliver ultra-efficient radiology services. At Chicago’s Northwestern Medicine, Molina’s role is unique – she is the only 5-day a week Interventional Radiology department specific PA. Yet her focus expands beyond just numbers. Molina has proven that time spent with her patients building trust, gathering information, and calming anxiety is just as valuable as her procedural skills as an IR physician extender.

Molina’s versatility as a physician’s assistant with an IR technologist background allows her to round on patients, run an IR minor procedure room, communicate with referring physicians, and triage patients for the attending. She also works closely with residents and fellows. This drastically reduces the time that attendings need to be involved, freeing them up to engage directly in more complex cases. It is no surprise that caregivers, patients, and administrators ask for her by name. Her distinct value includes understanding the scope and flow of the IR business, intuitively knowing which procedures will work best, and providing an educated voice in communicating with the patient, she said.

It turns out Molina’s collaborative approach and focus on trust drives quantitative results. She has directly reduced delays in performing procedures and created an overall increase in volumes. Sometimes the simplest actions have cleared big bottlenecks: checking in on patients at home postprocedure, acting as a point of contact for other departments, or personalizing care for repeat patients.  

Molina’s span of effort represents the inevitable shift in radiology quality. Demand for procedural output rates will certainly continue, but radiology operations that thrive in the future need a new brand. Value driven services, empathetic teams, and patient-centered, comprehensive care are required.

For radiologists, the era of solitary, episodic care is ending. Attracting patients, insurers, and staff requires forward thinking. Even as the industry is transitioning to new, value-based metrics, patient surveys are clear: consistency, communication, timeliness, and compassion matter.

Fortunately, change isn’t on radiologists’ shoulders alone. Savvy practices are designing teams that span all phases of patient experience and use extender roles to build effective bridges between radiologists and their patients while enhancing productivity. When both the radiologist and extender are able to perform efficiently by partnering in a patient’s care, they can provide the highest quality of service simultaneously.

David Partridge, director of imaging at OhioHealth Neighborhood Care, has used nurse navigators in his outpatient centers for almost ten years. As a first point of contact, the navigators helps guide patients through the breast imaging process. Addressing concerns from the moment of scheduling through their course of treatment has helped effectively speed up the time from detection to diagnosis and treatment. Historically, “breast imaging patients were dealing with traumatic reports, time lapses between exam and diagnosis, and a multitude of issues related to scheduling surgeries and dealing with their diagnosis”, Partridge said.  By providing comfort, reassurance, and expertise, the nurse navigator will often problem solve the needs of the patient and pull in the appropriate physicians as needed.

As a result, OhioHealth patients are more informed and comfortable with their next steps while receiving comprehensive care. By acting as a communications hub, navigators are able to speed up treatment plans and even schedule same day biopsies. The patient avoids phone delays, referring physicians continue to refer, and patient satisfaction scores are consistently high.

“Patients continually comment on how grateful they are to have this level of interaction and assistance,” He said.

For Partridge, navigators and other extenders are no longer optional but a powerful care model effective for both patient and staff satisfaction. OhioHealth is now studying how to reapply success to all outpatient imaging centers and within other areas of oncological care.

Delivering a complete, trusted patient experience can be wholly compatible with that enduring clinical problem of too few radiologists.

Seven years ago, Leslie Partridge, RRA, joined a radiology group at Ohio State University Wexner Medical Center to help an overworked practice. Formerly a charge technologist, there was no learning curve when she was initially brought onboard as a radiology assistant to relieve burdened schedules, procedures, and staff in the center’s fluoroscopy department.

As a clinical caregiver, educator, trainer, and point of contact, her team provides new patient value and differentiated services.

In partnership with a radiologist, Leslie performs hysterosalpingograms, lumbar punctures, myelograms, and a variety of GI work. Leslie reviews prior images, contraindications, medications, and allergies while working with the radiologist during crucial moments. She also acts as a second educated set of eyes to communicate observations. Most valuably, her immersion gives patients a new, trustworthy link to their procedures and radiologists can manage more and varied duties.[[{"type":"media","view_mode":"media_crop","fid":"49095","attributes":{"alt":"Patient-centered radiology","class":"media-image media-image-right","id":"media_crop_481888096579","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5906","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Aha-Soft/Shutterstock.com","typeof":"foaf:Image"}}]]

Leslie’s consistent exposure and seasoned expertise means she is also an ideal leader to train and lecture new residents. Personally, her fluoroscopy expertise is strong, and she’s considered an approachable, trusted face within the department.

While U.S. state regulations currently vary, the success of Lesley in her patient-facing RA role suggests progress is ahead for changes to her mid-level provider status regarding radiologist supervision, billing, and credentialing.

More broadly, patient-centered care standards for both extenders and radiologists are not measured or required, yet.

C. Mathew Hawkins, MD, chairman of the Quality Experience Committee for the Commission on Patient and Family Centered Care (CPFCC), is a strong supporter of nonphysician provider roles within imaging to bridge the gaps between radiologists and patients. To create a mature culture of quality, collaboration needs to be verified in ways consistent with new regulatory models that will focus more closely on patient-driven value metrics.

His committee includes patients and interdisciplinary colleagues already focused on defining value from the patient’s perspective and how best to deliver quality experiences in consistent, accountable ways. It is their job as part of the ACR to provide “quality verified, validated patient experience metrics that can be measured and reported on.”

Value needs to be thought of creatively and varies between subspecialties, according to Hawkins. From a patient perspective, experience quality may have softer, less measurable traits than the more defined volume-based metrics of the past. Patients think like consumers and want service that is more hospitable. For example, physically accessible imaging centers with convenient appointment times may be far more attractive than even the highest-ranked hospitals that stick to confusing and time-consuming physical or digital entry points.

Recent changes in fee-for-service models may continue to act as a catalyst for value metrics, but Hawkins also sees radiologists taking serious and personal accountability for patient care alongside extenders.  More or better visibility within the care team has a high impact on patient perception of treatment. At RSNA 2015, many radiologists spoke openly about ways they were contributing in meaningful ways large and small regardless of specialty.

As a pediatric interventional radiologist, Hawkins understands the direct value he can provide as a modern, “patient-facing radiologist.” Beyond his procedural care, providing his phone number to a patient’s parents, answering questions directly, and being available to families for follow-up discussions reflect the commitment of his practice.

Patient-centered radiology is a team effort. Singular accountability coupled with strong partnerships that drive unified, positive patient experiences are the winning formula to achieving high value. Despite some resistance to change, Hawkins said this model is representative of “a growing cadre of radiologists who realize they need to differentiate themselves in some way, otherwise they will be of little value to the patient.”