Only a few radiologists understand how to make a policy case for the value of diagnostic procedures. More need to contribute to research and prove that continued coverage is worthwhile.
In this new climate of health care reform and the emphasis on value, it’s time for radiologists to do their share of health services research, said Christopher I. Lee and Howard P. Forman in the May issue of the American Journal of Roentgenology. They argue that that the radiology field no longer has the luxury of choice in doing this research. No one can represent diagnostic radiology’s interests like a diagnostic radiologist.
“In this new era of health care, all specialties including radiology will have to show evidence of their added value to the well-being of patients. In fact, within the envisioned multidisciplinary, integrated, patient-centered medical home, physician compensation may become tied less to the quantity of studies and procedures completed and more to the quality and value of consultation services provided,” they write.
The health care financing shift began with the American Recovery and Advancement Act of 2009, where the government earmarked $1.1 billion for comparative effectiveness research. This was followed by the landmark Patient Protection and Affordable Care Act of 2010, which overhauled the system, and aims to provide patients with increased quality of health care at decreased costs. It changes the payment paradigm, financially rewarding accountable care organizations that lower overall medical costs.
The authors argue that while the new evidence-based system will vastly change the way that radiology services will be reimbursed in the future, “there are few in the radiology community who understand how to go about making the policy case for our contributions to the general population’s well-being.” And the research that will guide the policy will come from health services research.
What kind of input should radiologists be contributing? The authors gave these examples:
- developing automated medical decision-making tools to determine the most appropriate imaging procedures
- incorporating appropriateness criteria into computerized physician ordering systems
- showing short- and long-term effectiveness and cost-savings of various imaging and interventional procedures, along with quality-of-life considerations
- developing monitoring systems and policies for cumulative radiation doses
“It is no longer enough for radiologists to understand just the imaging findings,” the authors said. “All of us will need to understand how our imaging impressions and recommendations impact patient care on the individual and population levels and show our added value to multiple stakeholders.”
The dearth of radiology health services research has had a huge (and negative) impact several times in the 10 to 15 years. Researchers cite the 2005 Deficit Reduction Act, where the government cut $2.8 billion in payments for imaging services over five years, and the community was unable to show evidence of their value or cost-effectiveness. They also cited the controversial U.S. Preventive Task Force recommendations for screening mammograms for women 40-49. Authors note that the panel included experts in health care research methodology in various specialties - none were radiologists.
The authors encourage a top-down approach to training more radiologists in this arena, with radiology leadership groups needing to make financial investments in training. Younger radiologists also need to know about the training opportunities current available, which aren’t well publicized in this specialty.