A growing number of radiology groups, like at Mass General, are delving into direct patient consultation. But reimbursement lags for the in-demand service.
For years when Jennifer Kemp, MD, answered the phone inside her Colorado reading room the call was always from a referring physician with a question about a patient’s imaging report.
Then, about a year and half ago, the calls started to come directly from patients.
It turned out the referring physicians were handing the reports to patients who asked for copies. On the bottom of each report Kemp and a group of her colleagues within Diversified Radiology of Colorado PC include the phone number to the reading room as a standard practice. The sentence inviting calls simply reads, “if you have questions” to call, Kemp said. “It doesn’t specify who,” she said.
At first the patient inquiries were sporadic, but quickly the patient calls have become routine. The language at the bottom of the report remained unchanged. Today Kemp fields about two patients calls a day, with each lasting on average 20 minutes. She isn’t reimbursed for the time or expertise, but it is a part of her job she embraces.
“I love when the patient can give me more clinical history and tell me more about what’s going on, it helps me read images,” Kemp said. “I find it personally rewarding, and I feel it makes me a better radiologist and I am better able to understand what the patient wants and to kind have a better connection with the patient.”
Kemp is part of a small, emerging number of radiologists who are delving into patient consultation, as persistent patients have demanded more knowledge of their medical tests, diseases and treatments.
Kemp’s foray into consultation was organic, but others have been more direct. At Massachusetts General Hospital the Department of Radiology took a more formalized approach to consultation imaging patients by setting up a clinic dedicated to answering patient question.
Last year, the department established its Radiology Consultation Clinic as a pilot program geared towards providing additional information directly to patients in one-on-one meetings. The clinic is mostly aimed at cancer patients and people who have questions about an incidental finding, Choy said, noting that it is taking direction from mammographers and interventional radiology, where patient contact is commonplace.
The clinic’s goal is to support the patient and the referring physician by improving the understanding of radiology reports, but also to educate patients about the practice of radiology and the risks and implications of radiation.
“We stared to realize our referring physicians, and primary care physicians in particular, had questions for us from their patients,” said Garry Choy, MD, one of the clinic’s founders. “They wanted us to comment and clarify. Patients started to read reports and get closer to their imaging results and they wanted to know what certain terms meant.”
Previously the referring physicians and primary care doctors were acting as proxies for the patients. The consultation clinic allows radiologists to “be on the front lines,” Choy said.
The radiologists, however, didn’t want to take over the process of delivering the results to patients. That message, Choy said, is best left to the physician presiding over the entire treatment plan of the patient.
The program at Mass General has been slow to gain traction, with between two and five consultations occurring each month, Choy said. Appointments last an average of 30 minutes.
Still, among the patients who have come to the clinic, the early results of the pilot are positive, he said.
For patients, the clinic serves mainly as educational tool, with patients voicing appreciation for being able to look at the images along side the expert, Choy said.
“Being able to go over [the images] with the radiologist is deeply meaningful and empowering, because they are trained to look at imaging from many, many lenses, where other doctors are looking at it only from the particular lens of their specialty,” said Nila Webster, one of the patients who has met with Choy in the clinic.
Webster, 49, has Stage 4 lung cancer, but said her visits to the clinic after each CT scan are key to her effectively dealing with her disease and understanding her body’s response to treatments. Her only frustration is that she is not able to pay for the service that she deems so valuable to her care.
For now, both the Mass General clinic and Kemp’s consult services are free. Currently there is no reimbursement code that allows radiologists to bill for the service, Kemp said. But payment for patient consultation is something radiologists will have to address, especially as bundled payments, medical teams and patient-centered care continue to be emphasized in health care reform, she said.
Even in establishing the clinic at Mass General, Choy said they deliberately marketed the service to referring physicians as being part of the medical team, and not as an effort to overstep their role in a patient’s care. So far, referring physicians find the patient education component helpful, he said.
“They like it, but only if it is done in the appropriate way,” Choy said of his fellow physicians. “In the beginning, they weren’t sure how to work with us. They were fearful, or felt we were overstepping a little. They worried about what we were saying. But now they are more comfortable and see us as helpful in addressing patient imaging questions.”
Choy said the hope is to study to implications of the consultations once the clinic starts to draw larger volumes of patients.
“I don’t think we know all the answers, but what we’ve learned so far is there are opportunities in patient education,” Choy said.
The need to educate patients about radiology goes beyond just explaining an image or diagnosis, Kemp said, noting that consultation should be seen as one part of the larger patient-centered care effort in radiology.
Kemp, who is also part of a 10-member subcommittee on patient-centered radiology for the Radiological Society of North America, said it is important for radiologists to become a more visible part of a patient’s care. RSNA launched its Radiology Cares campaign in November as an effort to encourage that visibility in the field
“Part of what the Radiology Cares campaign wants to get across to other radiologists is if you hear this idea of patient consultation and you think, ‘There is no way I can do that in my practice,’ realize that there are other things you can do that can be more patient centered,” she said, including patient surveys and displaying a bio and photo of radiologists in the waiting room.
As part of the campaign radiologists are pledging to continue learning more effective ways to communicate with patients and referring physicians.
“We need to be making sure radiologists survive in the future as a specialty,” Kemp said. “We believe we are valuable, and referring physicians think we are valuable, but most patients don’t know that.”
Hear from patient Nila Webster in her own words: