Transcript Patient-Centered Radiology

Patient-centered Radiology
Sponsored by the
Patient-Centered Radiology Steering Committee
of the Radiological Society of North America
Rev 2014
Overview

What is patient-centered radiology?

Why should radiologists be patient-centered?

What does it mean to be focused on our patients?

Implementing Patient-centered Radiology: A Case Study
and Lessons Learned

How can radiologists be patient-centered?

The Radiology Cares® Campaign
What Is
Patient-centered Radiology?
Patient-centered Radiology:

Standardized reporting of results

Two-way communication regarding results between radiologist and
referring physician and between radiologist and patient

Realization that patient portals enhance the need for more
user-friendly language when reporting results

Understanding the importance of patient engagement

Improved efforts regarding the level of care patients receive

Convey to patients the essential role radiologist have in patients’
healthcare and safety – to ensure patients understand that
radiologists are more than just a name on a bill

Realize that many patients do not even know radiologists exist –
patient-centeredness includes any efforts to improve that perception
Patient-centered Radiology:
More than just talking to patients
 It means we consider the patient experience holistically -from scheduling through exam to reporting to billing to
future communications
 Assuring our patients we will do all we can to treat them as
we would a loved one
 As described by Richard B. Gunderman, M.D., Ph.D.:
“We must see the patient behind the image.”
“We, as radiologists, can begin to contribute by
being public champions of this new
patient-centered philosophy of care, and
committing ourselves to putting patients at the
center of everything we do.”
George S. Bisset III, M.D.
2012 RSNA President
President’s Address
Patient-centered Radiology:
Components:
Scheduling
Registration
Billing
Results
Reporting
http://www.hoaghospital.org/radiology/
PATIENT-CENTERED
EXPERIENCE
Reception
Caregiver
Interactions
Why Should Radiologists
Be Patient-centered?
“Professionalism is the basis of medicine’s contract
with society. It demands placing the interests of
patients above those of the physician...”
Excerpt from
Medical Professionalism in the new millennium:
A Physician Charter
ABIM Foundation
ACP-ASIM Foundation
European Federation of Internal Medicine
Maintenance Of Certification (MOC)
Fulfills 3 of 6 competencies required
for MOC:

Interpersonal and communication skills

Patient care

Professionalism
Patients Ask:
What’s So Special About Radiologists?

Radiologists take a more responsible safety stance
toward lifetime radiation dose

Radiation dose and patient safety: we know about
it, we tell patients about it, and we practice it

We have the highly specialized training and
expertise to know the right test, when to order it,
and how to interpret it
Key Observations
About The Radiology Specialty

Radiology is successful!

Success breeds complacency – COMPLACENCY
BLUNTS APPROPRIATE RESPONSE TO THREATS.

Success breeds persistence in what we do well
(despite obvious threats), at the expense of
adaptability and innovation.
Doctor-Patient Relationship

Traditional, built on familiarity and trust

The foundation of the place and influence of
physicians in society
Yet it’s:

Weak to non-existent in radiology
Glazer GM, Ruiz JA. The State of Radiology in 2006: Very High Spatial Resolution but No Visibility.
Radiology. 2006; 241:11-16
Consider:
“…the invisibility of radiologists perpetuates the
misperception that many imaging services are
commodities.”
“By offering an even higher level of personalized service
through direct communication, radiologists can dispel this
viewpoint by showing patients that they customize
imaging examinations to fit each patient’s individual
health care needs.”
Gary M. Glazer, M.D. and Julie A. Ruiz-Wibbelsmann, Ph.D.
The Invisible Radiologist. Radiology 2011; 258:1, 18-22
Consider:
Competition from other specialists

...cardiologists, orthopedists and others who want
to do imaging

Coalition for Patient-Centered Imaging,
American College of Cardiology, and other
specialty associations
For Example,
consider this excerpt from the Coalition for
Patient-Centered Imaging:
“The Coalition represents the undersigned healthcare
organizations committed to ensuring that patients have full access
to high quality, convenient, and up-to-date imaging technology…
organized in response to efforts to limit the availability of imaging
services provided in physicians’ offices… such as
obstetricians/gynecologists, neurologists, orthopedic
surgeons, cardiologists and urologists.”
http://www.acc.org/advocacy/advoc_issues/imaging_021005.htm
Consider:
Developments in Our Technology
... “disruptive technology”
that has potential to
diminish need for or
visibility of radiologists,
e.g., teleradiology, CAD,
PACS….
Example:
Computer-aided detection (CAD)
mammogram
Eliminate Perception
Of Radiology As Commodity

Nighthawk: Removes you from the point of service

Delegation of services to faceless provider

“Anyone can do this”

Devalues work effort

Exposes the high margin – promotes price competition
Radiology As Commodity: Drivers

Consumer Driven Care

PACS/Teleradiology



CAD
•
Demystification of the technology
•
In-office clinician imaging
•
Corporatization of Radiology
Internal Factors
•
Volume per FTE: The Time/Money Dynamic
•
Lack of Sub-specialization
•
Nighthawk
•
Radiologist “Culture” (lifestyle, entitlement mentality, addiction to
pathological democracy)
Imaging services provider RadNet of Los Angeles received a $110 million loan
from GE Healthcare Financial Services (Reported in January 2008)
Time For A Change
“…patients’ expectations have changed. Most patients
want to talk with their health care providers and to play
an active role in health care decisions.”
“… radiologists are still entrenched in the historic cultural
practice of communicating with referring physicians only
and not with patients.”
Glazer GM, Ruiz JA. The State of Radiology in 2006: Very High Spatial Resolution but No Visibility.
Radiology. 2006; 241:11-16
Change Isn’t Easy…
Especially Cultural Change

Culture eats strategy for lunch…

But good management can change culture

And, it’s time for a change!
Why?
Important Strategy Insight
 Postulate: An organization’s strategy cannot
succeed unless it is aligned with the industry’s
change trajectory.
 Def: The change trajectory is determined by two
threats of obsolescence:
o Threats to industry’s core activities
o Threats to industry’s core assets
McGahan AM. How Industries Change. Harvard Business Review. October 2004
Radiology Core

o

o
Core activities: the production, interpretation and distribution of
quality imaging studies of patients. Threatened by new outside
alternatives.
Threats: competition from cardiologists, orthopedists and others who
want to do imaging work (outside alternatives).
Core assets: independent, integrated subspecialty, whole body
knowledge, brand name, early access to “state-of-the-art” technology,
visual experience with in vivo pathology. Threatened by changes that
diminish value.
Threats: disruptive technology that diminishes need for
radiologists/imaging studies/equipment or supplants our diagnostic
capability, e.g., teleradiology, CAD, genomics… (diminished value).
Change Trajectory
Politics, medical industry, Internet culture pushing
patients towards more self reliance:

Payor/physician culture is excessively paternalistic,
controls the practice of medicine and patient referral

Restricted access

Patients distrust system, sense managed costs,
not managed care
Change Trajectory
Mainstream medicine is becoming consumer driven:

High deductible health insurance, HSAs

Patients have access to medical information and suggested
treatment (WebMD, TV, print ads, etc.)

Direct patient marketing by pharmaceutical companies, doctors,
hospitals, university medical centers

Self-medication with over-the-counter, non-prescription items

Self-referral for mammograms, UAE, coronary CTA increasing

$50 billion alternative medicine industry
The End Of Managed Care
“By default if not by design,
the consumer is emerging as
the locus of priority setting in
healthcare.”
James C. Robinson, Ph.D., M.P.H.
Chair, Berkeley Center for Health Technology,
University of California, Berkeley
The end of managed care. JAMA 2001 May
What Patients (And Others) Want

Patient-centered care promoted by Centers for
Medicare & Medicaid Services (CMS) and many others

Metrics exist and are being developed

Practice performance is a matter of public record
CAHPS
Consumer Assessment of Healthcare Providers
and Systems

Surveys and tools to advance patient-centered care

ABMS incorporated CAHPS patient survey into MOC
standards

Health care quality information from the consumer perspective

27-question survey developed and cleared for public use
January 2006

Data published beginning of 2008

www.cahps.ahrq.gov
Some CAHPS Survey Topics
Relevant To Imaging

Communication with doctors

Communication with nurses

Responsiveness of staff

Discharge information
Why Be More Patient-centered?

We are physicians; professionals

Maintenance of certification (MOC)
requirement

We’ve been “invisible” too long

Competition from other specialties

It is what patients (and payors) want

Rendered anonymous by our own technology
What Does It Mean To Be
Focused On Our Patients?
Put Patients First

Minimize delays

Increase communication

Create a welcoming
environment of caring,
responsive people
Perception Is Reality…
Waiting Room
“LOUNGE”
What Patients Want
Lessons from Colon Screening Experience:

Easy appointment access

Information content of study
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“Face Time” with doctor
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Rapid feedback

Reassurance or rapid triage
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Cost flexibility
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Transparent pricing and billing

Self-reliance… greater degree of control!
Implementing
Patient-centered Radiology:
A Case Study & Lessons Learned
Hoag Memorial Hospital
Presbyterian
Newport Beach, California
A Case Study
Background On Hoag Hospital

498-bed acute care not-for-profit hospital
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JCAHO accredited
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Designated Magnet Hospital
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Distinguished Hospital Award for clinical excellence and patient safety
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338,000 imaging studies performed in 2008
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386 radiology employees and 27 radiologists
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7 outpatient imaging centers
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State-of-the-art Breast Care Center
A Case Study
Accuracy Of Appointment
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Correct exam scheduled?

Preparation given to patient?

Arrival time and exam time explained?
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Right time, right location, right preparation?

Lost physician orders = Loss in patient confidence
A Case Study
Patient Access

Outpatients are likely to seek alternate provider if
backlog is greater than 2 days

Backlogs can drive no-shows
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No-show rates may be higher than you think

Revenue opportunity is significant with backlogs
A Case Study
Reception

Greeter during peak volumes

Manage patient arrivals

Improve waiting room
environment

Invite patients to inquire
about delays
A Case Study
Measure The Steps…
Focus On Sources Of Variability
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Radiologist speed
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Workload

Number of radiologists on duty
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Number of transcribers (editors) on duty

Track radiologist variables that can lead to overall backlogs
and failures

Implement voice recognition solution
A Case Study
Report Turnaround Times
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Hoag Hospital report turnaround time =
99% less than 8 hours

Best in Class benchmark less than 4 hours
o
< 8 hours 10%
o
< 4 hours 15%
o
< 1 hour 12%
o
< 5 minutes 63%
Data source: Hoag Hospital CPOG report Jan-Dec 2005
A Case Study
Lessons learned
Patient Delays And Wait Times
You can’t manage what you can’t measure
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Reduce bottlenecks
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Apply same rigor to add-on and walk-in patients
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Patients deserve to know why they are waiting

Improve exam start time
A Case Study
Lessons learned
Understand Your Customer’s
Expectations
Inform the patient when they should expect their exam results
A Case Study
Lessons learned
Billing Accuracy:
Related To Patient Satisfaction
Accuracy of charges:
Correct billing is a critical factor in becoming a high
performing patient-centered radiology department.

Verification of authorization prior to performing exam

Check outstanding balances, contact patients for payment
prior to visit
A Case Study
Lessons learned
Billing Accuracy:
Related To Patient Satisfaction

Notify patients of out-of-pocket payments at
time of scheduling

Patients deserve to know the cost and quality of
the product

Increased consumer interest in price shopping
will influence choice of facility
How Can Radiologists
Be Patient-centered?
Be Visible

Meet and greet

Discuss results

Make the
radiologist-as-physician
connection with
your patients

Give radiologists a face and a value as part
of the healthcare team
Sick and Scared, and Waiting, Waiting, Waiting
By Gina Kolata
Published: August 20, 2005
“Freddie Odlum spent two terrible days waiting by the phone for her
doctor to call. She had had a CT scan to investigate a suspicious
mass in her lungs and Ms. Odlum, a Los Angeles breast cancer
patient, was all too aware that if the cancer had spread, her prognosis
would not be good.
“But her doctor did not call [for several weeks]. … The scan did not
show cancer, but she could not forgive her doctor. ‘This internist had
been my family doctor for years,’ Ms. Odlum said. … ‘I never spoke to
him again.’”
Kolata G. (2005). Sick and Scared, and Waiting, Waiting, Waiting. The New York Times.
Sick and Scared, and Waiting, Waiting, Waiting
By Gina Kolata
Published: August 20, 2005
“Freddie Odlum spent two terrible days waiting by the phone for her
doctor to call. She had had a CT scan to investigate a suspicious
mass in her lungs and Ms. Odlum, a Los Angeles breast cancer
patient, was all too aware that if the cancer had spread, her prognosis
would not be good.
Patients expect
timely
results
“But her doctor did not call [for several weeks]. … The scan did not
show cancer, but she could not forgive her doctor. ‘This internist had
been my family doctor for years,’ Ms. Odlum said. … ‘I never spoke to
him again.’”
Kolata G. (2005). Sick and Scared, and Waiting, Waiting, Waiting. The New York Times.
What Radiologists
Need To Do:

Differentiate your practice

Provide great local services

Provide personal service
Position Yourself
As The Medical Imaging Expert!

Communicate with your referring physicians

Use Tumor Boards / interdisciplinary opportunities
to embed as an essential member of team

We are honest brokers – responsible medical
imagers without vested interests. Describe
yourself that way
Enhance Visibility Of Radiologists

Get out in front!

Post photos of radiologists
in hospitals

Include radiologists’ signatures on
patient reports

Give patients your card
(with home phone!)

Call your patients – make direct
referrals
Develop Patient-centered Communications
Example of a Patient-centered Letter to Patients with emphasis on Radiologist involvement
Dear Patient:
Thank you for choosing Newport Harbor Radiology Associates. We are the physicians who perform and interpret the
procedure you had today. You can be assured that a board certified radiologist, one of our group’s expert sub-specialist
physicians, supervised and interpreted your procedure today.
The results of your procedure are being forwarded to the physician who referred you for this procedure. If you have any
questions, consultation with your physician will be of value. Should you need further clarification, feel free to contact us.
Our radiologists are acknowledged experts in their field, some of our doctors having pioneered many of the
radiology procedures being performed today. We aim to provide the highest possible level of care in a sensitive and
patient oriented environment. We provide consultation not just to your doctor, but to other radiologists and physicians from
outside this region, and help educate such physicians in the latest and most appropriate techniques tailored to a given
diagnostic and therapeutic need … We staff Newport Imaging Center, and all of Hoag Hospital’s Radiology facilities.
If you require a copy of the results for your files, or a copy of the images themselves on CD, please let us know. You
can make this request at the front desk or by calling <<(949)xxx-xxxx>> and our staff will make these arrangements
for you.
Newport Harbor Radiology Associates offers the most advanced, comprehensive imaging services, radiological
studies, and image guided treatments in all of California. To learn more, visit our web site at <<<<fill in>>>>>. To
schedule your next appointment, call <<<< fill in>>>>> . We look forward to providing imaging services for you again.
Sincerely,
The Physicians of Newport Harbor Radiology Associates
Added Value/Competitive Advantage
Of On Site Radiologists

Supervision of equipment, choices, discounts

Quality control / peer review / JCAHO standards / credentialing

Participation in medical staff governance

Participation in hospital operations

Involvement in strategic planning

Attendance at organizational meetings

Promotion of services
Voice Recognition
And Self-Edit Reporting
Accurate, standardized, understandable reports
provided in the fastest
time possible.
Whose responsibility?
You are the master of your final product!
Schreiber MH, Leonard Jr M, Youmans Rieniets C.
Disclosure of Imaging Findings to Patients Directly by Radiologists: Survey of Patients’ Preferences.
American Journal of Radiology 1995; 165:467-469
Lessons Patients Learn From
Talking With Radiologists
Patient communication can take the radiologist
from the back room of doctor-to-doctor consultation
to the front office of
direct patient-centered
care and clinical medicine.
Lessons Patients Learn From
Talking With Radiologists

Radiologist as Imaging Expert, Knowledgeable Physician

Radiologist as Patient Advocate

Radiologist as Gatekeeper

Radiologist as Referring Physician
Patients Want Results From
Radiologists
Survey of 261 patients:

92% wanted to be told of normal results

87% wanted to be told of abnormal results
Schreiber MH, Leonard Jr M, Youmans Rieniets C.
Disclosure of Imaging Findings to Patients Directly by Radiologists: Survey of Patients’ Preferences.
American Journal of Radiology 1995; 165:467-469
Trepidation Of Disclosure
Unfounded

Majority of test results are normal, or do not indicate
life threatening conditions

96% of 287 patients: test normal, or non-malignant
condition
Vallely SR, Manton Mills JO. Should Radiologists Talk to Patients?
British Medical Journal 1990; 300:305-306
Trepidation Of Disclosure
Unfounded
Radiologists need not be afraid of disclosure!

In 2003, 1,275,300 newly diagnosed cases of
cancer, and 23,345 radiologists

Even if every case is diagnosed by a radiologist,
that’s one abnormal result per week per radiologist
American Cancer Society (http:www.cancer.org)
Pasko T, Smart D. Physician Characteristics and Distribution in the U.S. JAMA 2005; 1
What Is Radiology Cares?
 Patient-centered Radiology initiative
 Launched at RSNA 2012
 Represents years of evolution of refresher courses, meetings,
workshops
 Overseen by the RSNA Patient-Centered Radiology Steering
Committee
Vision
Patients are the primary focus of radiologic care.
Mission
The Radiology Cares® campaign mission is to encourage and
facilitate radiologists’ meaningful engagement in the patient
experience.
Goals
To promote:
 Alignment of radiology practice with patients’ needs and
best interests.
 Optimal patient experience throughout the continuum of
their radiologic care.
 Effective communications with patients and other
healthcare providers, thus empowering patients to make
informed decisions regarding their medical care.
MODEL OF CARE

www.RadiologyCares.org

Radiologist resource for
patient-centered care

Access to related scientific and
consumer media articles and videos

Available customizable presentation decks

Source to take the Radiology Cares® pledge in support of
patient-centered practices
Patient-centered Future Initiatives

One-stop registration and scheduling to include Web-enabled
appointment access for patients and referring physicians

Patient-accessible Web page
o
Results
o
Consult with a radiologist

All patients requiring radiology services will be able to schedule their
appointments (or drop in), have their exam completed and their report
available to their physician all within the same working day

Patients leave imaging center with results

Greater radiologist / patient interaction
Spread The Word About
Patient-centered Radiology

Meet your patients

Contact your referring physicians

Convince your radiologist peers about the importance
of patient interaction

Present this customizable talk to your colleagues
Resources At Your Fingertips:

RadiologyCares.org

RadiologyInfo.org

ImageGently.org

ImageWisely.org
An Available Quality Patient
Communication Resource:

www.RadiologyInfo.org

Reassures patients and saves physician time

Free, credible radiology information
in lay language

Over 135 radiologic procedures and
disease/condition descriptions

Tells your patients what to expect

Reviewed by radiologists (RSNA and ACR)

Available in both English
and Spanish
Tell Us Your Stories…

Describe clinical scenarios where your patient
interaction was meaningful to the patient and the
medical outcome

Tell us about your successful patient–centered
radiology programs. How do you practice it?

Send stories and examples to RSNA at
[email protected]
Presentation Contributors

Philip O. Alderson, M.D.

Michael Brant-Zawadzki, M.D.

Marcy A. Brown, A.R.R.T

Carol M. Rumack, M.D.

Eric J. Stern, M.D.

Joseph H. Tashjian, M.D.

Susan D. John, M.D.

Harvey L. Neiman, M.D.