Experts at RSNA 2017 encourage price transparency and structured radiology reports.
Radiology’s claim to fame - it’s role in health care - has always been the providers’ ability to interpret images. Without that skill set, diagnosis isn’t possible.
But, in today’s health care environment the profession can offer more than just interpretation to demonstrate how it contributes to quality patient care and satisfaction.
According to industry experts at RSNA 2017, noninterpretive activities are immensely important.
More specifically, radiologists can make a significant impact through price transparency and structured reporting.
When you buy a gallon of gas or reserve a hotel room, you know exactly how much you’ll pay. But, that’s not the case for a MRI or CT scan. A patient’s total cost depends on a lot of factors - where they get scanned, what insurance they have, and what the hospital prices are to begin with. And, they still don’t know their final bill until after they’ve had the study completed.
This uncertainty can be daunting because the price of health care continues to rise. Since 1999, said Mark Hiatt, MD, executive medical director of Regence BlueCross BlueShield in Utah, there’s been a 200% increase in health insurance premiums and worker contributions with no commensurate uptick in wages. Consequently, employers are actively looking for ways to help employees control their own health care costs.
One way to combat this problem, he said, is to empower patients to choose how they wish to receive services.
“Many don’t even realize they have a choice or a means to compare prices,” Hiatt said. “If you give them tools, they can make informed decisions about the cost of their health care.”
Either payers or providers can help patients with price transparency, he said. It requires some work and coordination, but the results can be positive.
Payer assistance: In this model, the payer reaches out to the patient when there is a substantial difference in price for a study at two different locations. If the patient opts to receive services at a less-expensive location, the payer cancels the previous appointment and books the new one.
This decision can only be made if the cost difference is measurable and before the patient undergoes the study. It’s also best, Hiatt said, in urban locations where patients have greater access to more choices.
Based on Regence data, patients who chose the more affordable option save approximately $220 per test - a 20% reduction in price. The benefits also extend to those who don’t select the cheaper option. They still save money, he said, because providers and facilities lower their prices to stay competitive.
Provider solution: Individual facilities can also take steps to help their patients save money, he said.
For example, Mountain Medical in Utah recognized in 2010 that its two free-standing imaging centers offered services for 40% cheaper than the hospital. In 2011, they launched a provider education program that encouraged physicians to send patients to the imaging centers. They also marketed the services direct to the consumer via newsletters and billboards, as well as word-of-mouth.
In 2012, they evaluated their progress and saw significant results. Three times as many patients were opting for imaging services at the free-standing centers, totaling a 22% increase in volume.
Ultimately, Hiatt said, price transparency will help control cost and spending from the employer, payer, and patient perspectives. It could also help radiology chip away at its reputation as a cost driver.
“We’re going to have greater dependence on people paying for their own health care,” he said. “Increasingly, in the future of health care we’re going to have a consumer-centric model where there’s less marketing of services from business-to-business and more health care plan-to-consumer.”
In addition to taking steps to keep imaging costs low, radiologists can positively impact patient care by improving how referring providers digest reports, said Eduardo Mortani Barbosa, MD, assistant professor of radiology and director of CT modality in the thoracic imaging section at the University of Pennsylvania Perelman School of Medicine.
“The report is the center of what we do. It’s documentation of what we did. It’s important to billing compliance, and it’s our best defense,” Barbosa said. “But, overall, it’s a communication tool of our thought process from patient diagnosis to prognosis to treatment management.”
It’s been shown that structured reporting increases efficiency, lowers cost, and improves outcomes, he said. But, that’s only possible when reports are comprehensive, consistent, and clear. In those instances, not only can they improve clinical utility, but they can also augment data mining and information extraction to bolster patient care.
In addition to being an invaluable education tool, demonstrating best practices for residents and fellows, a well-structured report can also improve clinical guideline adherence, and reduce errors.
To ensure you have an effective structured report, look for these characteristics, he said:
1. Institutional buy-in.
2. Research to show it works well.
3. Safer and easier dictation.
4. Clear and consistent communication.
5. Flexibility, such as narrative reporting, for complex cases.
6. Automatically captures relevant information from the RIS as much as possible.
The best system design should also include these factors:
1. Several templates
2. Auto-populated information
3. Macros for terms used more than 10 times a day
There are still opportunities for growth and improvement in structured reporting, Barbosa said. Look for developments in hypertext reports that allow for the inclusion of images, graphs, and tables, as well as image overlay and image comparison.