Real-Life Examples of Increasing Value in Radiology

November 5, 2015

How three radiology practices adapted to value-based care.

There’s a big emphasis in radiology on providing value, and going beyond just reading and interpreting images. Practices are trying different ways to add value to what they do, and it doesn’t have to be a big, expensive program. Below, Diagnostic Imaging is featuring three real-life approaches to adding value in a radiology practice, which involve consulting with patients, educating referrers, and restructuring a practice to provide financial stability and better technology.

Consulting Service for Patients

What They Did
The radiology department at Massachusetts General Hospital provides a complimentary consulting service for select patients. Residents rotating through the program (which takes place every Tuesday morning) identify patients coming in for routine visits at their PCP office. The resident contacts the PCP about a handful of patients with upcoming appointments and chronic issues identified in recent past imaging that can be impacted by lifestyle changes or medication. When the patient checks into the office, they’re asked if they’d like a 15-30 minute radiology consultation in addition to their PCP visit.

Each resident staffs the clinic two or three Tuesday mornings in a row after receiving training, and there’s an attending on call who frequently attends the consultation as well.

Mark Mangano, MD, chief resident in radiology at Massachusetts General Hospital, Harvard Medical School set up the program in early 2014, with a goal of making it self-sufficient. By having the residents screen the patients and talk to the PCPs before the visit, the residents have more ownership over the process and increased connection to the patient during the consult. Prior to the visit, the resident goes through the most recent PCP notes and can access the patient’s medical records to be prepared. Sometimes the PCP tells the radiologist what issues to help with, like encouraging a patient with atherosclerosis to take the prescribed statins.

Why It’s Valuable to Patients
Mangano said that a lot of the patients’ conditions are intangible and asymptomatic. It’s tough for them to understand the conditions fully without seeing imaging. “If we can explain it to them or get buy-in by showing imaging of their body, it’s direct evidence of what’s happening,” he said. While PCPs also have access to images and reports, they don’t show the images to the patients to the degree that radiologists do in the consultation.[[{"type":"media","view_mode":"media_crop","fid":"43052","attributes":{"alt":"value in radiology","class":"media-image media-image-right","id":"media_crop_691979228823","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4686","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: 180px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©america365_Shutterstock.com","typeof":"foaf:Image"}}]]

Mangano said he’s talked with patients who had been prescribed medications such a statin, but didn’t take them for various reasons. After meeting with the radiologists, some patients start taking their medication because they better understand their condition.

While they don’t have data yet to confirm the impact of these radiology consultations, there’s anecdotal evidence that the discussions were helpful. “The PCPs said it really impacted their patients, and completely changed their perspective of their health,” he said. Mangano said the radiologists have also gotten e-mails from patients thanking them for their time and emphasizing the value of the interaction.

Why It’s Valuable to Referring Physicians
While some PCPs might be wary of a radiologist giving medical advice to their patients, the radiologists stress that the consultation clinic is a collaboration between PCPs and radiologists. “The primary care physicians are very satisfied with it,” said Mangano. “By setting the tone and expectations with the PCP, there hasn’t been much of an issue. We want to do what’s best for the patients, and support the primary care physician so they can use us as an expert.” This saves the PCP time, and gives the patients input from another physician with a different perspective. “The point is to help patients together and break down the barriers between specialties,” he said.

While training the residents, they discuss the boundaries of what they’ll say to the patients. As for going outside their wheelhouse, Mangano said it’s not an issue. “As a physician, you should be comfortable talking about certain things,” he said. They’re not making recommendations for follow-up or changing medications, that gets deferred to the PCP.

Why It’s Valuable to Radiologists
The program has been a great experience for the residents and attendings. “It’s valuable to get the experience of talking to patients and honing and developing people and communication skills,” Mangano said. It helps the residents remember that their work has an impact on real people, something that can get lost in the reading room.

Brown Bag Lunch Information Sessions with Referring Practices

What They Did
Chambersburg Imaging Associates in Pennsylvania presents 15-30 minute “brown bag lunch” programs at referring practices, to highlight new technology or hot topics in radiology. For example, when breast density legislation was passed, breast imaging radiologists visited OB/GYN practices to discuss the screening guidelines and implications. “We brought mammogram films showing extremely dense breasts and fatty breasts, so the doctors and nurses could see the difference,” said Robert Pyatt, MD, president of both Chambersburg Imaging Associates and the Chambersburg Hospital medical staff. When they upgraded the coils on their MRI machines, they visited orthopedic practices who order hand and finger MRIs, to explain how the new technology would improve imaging.

Why It's Valuable to Patients
“The patients are going to get more appropriate imaging or better care,” said Pyatt. The physicians who learned about screening for women with dense breasts often now order an ultrasound in addition to mammography. That’s resulted in numerous breast cancers diagnosed in these women, when the mammogram alone wasn’t able to detect it. “That’s proved how valuable that is,” he said. The referring physicians now know to look for breast density in the mammography report when they order future tests.

Why It's Valuable to Referring Physicians
The lunch-and-learn sessions are helpful to referrers because they get updates on radiology topics that affect their patients. Since Chambersburg also brings their nurse navigator, the referring office staff can ask questions, including questions about scheduling. They bring a member of the management team as well, so that if the other practice raises issues, Chambersburg can get back to them promptly with answers. That said, “if you don’t follow through, you blow your chance. If you do follow through, you instill confidence. Then they don’t whine and complain when they see the hospital president,” he said.

Why It's Valuable to Radiologists
The short sessions allow the radiology group to get to know the referrers, and vice versa. “It gets the face with the name,” Pyatt said. It also allows them to introduce new radiologists. “There’s a lot of desire to meet colleagues.”

In addition, these educational sessions have increased business and “have helped prevent leakage of referrals to the competition. We’ve prevented volume from leaving by giving better service,” he said. 

What They’ve Learned
While the radiologists are there to provide education (and occasionally bring the food as well), they come ready to listen and solve problems. Two practices asked the radiologists for standardized reporting templates that presented the information the way the group wanted it. That change was made, satisfying both groups.

Pyatt stressed that it’s important to have the referring practices bring their key nursing staff and office managers to the sessions, as they tend to have good questions. Pyatt recommends giving the referring office direct contact information – a phone number they can post and call when they needed.

Pyatt cautions that radiologists have to be prepared to deal with negative feedback from the referral staff too. “It’s not all easy,” he said. “Sometimes you’re challenged with these sessions. Use it as an opportunity to fix problems.”

Joining Forces with an Academic Hospital

What They Did
When Long Island, New York-based Nassau Radiologic Group found themselves dealing with a marked decline in reimbursements, it affected their ability to make their desired capital expenditures. The payment declines going back to 2007 were difficult for operation providers, making it hard to keep up with some of the latest technology, said Eric Schnipper, MD, a partner with the former Nassau Radiological Group. They started looking into other business models.

This June, they consummated a deal with NYU, and the radiologists and staff are all now NYU employees. They also created a new entity of which the current radiology partners are partial owners.

“It’s a win-win-win for patients, the referral community and the radiologists,” Schnipper said. “We have the backing of a solid organization like NYU, and we’re able to use that to augment our patient care.”

Why It's Valuable to Patients
While Schnipper said the practice has always offered the highest quality care, “we feel we’re offering the patients a dramatic improvement in service by (NYU) allowing us to spend money we weren’t capable of spending on our own.”

He said the patients benefit from imaging and interpretations aided by state-of-the-art equipment, including the top scanners, PACS equipment, and improved information technology. Multiple radiologists can look at a case, if necessary, in real time. Patients like having the academic status of NYU, which is known on a national level, Schnipper said.

Why It’s Valuable to Referring Physicians
Schnipper said the group’s referral base is loyal because they know the high quality of service they’ll receive. “The people within our organization make a big difference,” he said. “They know that when they need an interpretation rendered, the same people are here as before.” Plus some referring doctors are also affiliated with NYU, “which further strengthens the bond. They can look in their own data systems and look at the study right away,” he said.

Why It’s Valuable to Radiologists
“The financial security that a hospital has is difficult to replicate in a private practice,” Schnipper said. “As a result, [the affiliation] became a no-brainer.” He said the employment benefits offered by a large hospital, including outstanding health care and a matching 401k plan, are also attractive.

The radiologists now have the best equipment and reading stations, he said, along with access to “the brightest minds in imaging.”

Since the affiliation, Schnipper said he’s heard anecdotal stories of some referrers going elsewhere, but he doesn’t think it’s been a major problem for the practice. He anticipates that they’ll gain new referrers because of the NYU network.

“We now sleep better at night with our affiliation.”