Transcript Patient-Centered Radiology

Sponsored by the
Patient-Centered Radiology Steering Committee
of the Radiological Society of North America
[ Insert organization name ]
Rev 2014
[ Insert organization name ]
Overview
 What does it mean to be focused on our patients?
 Why should radiologists be patient-centered?
 How can radiologists be patient-centered?
 Implementing Patient-centered Radiology:
A Case Example and Lessons Learned
 Resources
 Discussion
What Does It Mean To Be Focused
On Our Patients?
Time For A Change
“(Radiologists) must more vigorously
demonstrate their ability to provide a broader
bandwidth of patient care, including greater
patient interaction. This fits the change
trajectory of the health care industry in which
politics, economics, the medical culture, the
Internet culture, and the media are all pushing
patients toward more self-reliance.”
Brant-Zawadzki M and Kerlan RK.
Academic Radiology. 16(5), May 2009
Lessons From Colon Screening:
Patients Want…
 Easy appointment access
 Information content of study
 “Face Time” with doctor
 Rapid feedback
 Reassurance or rapid triage
 Cost flexibility
 Transparent pricing and billing
 Self-reliance… greater degree of control!
Patient-centered Radiology
The components:
Billing
Results
Reporting
http://www.hoaghospital.org/radiology/
Scheduling
Registration
PATIENT-CENTERED
EXPERIENCE
Reception
Caregiver
Interactions
Perception Is Reality…
Waiting Room
“LOUNGE”
Putting Patients First
 Minimize delays
 Increase communication
 Create a welcoming
environment of caring,
responsive people
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
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
Radiology Core
 Core activities: the production, interpretation and
distribution of quality imaging studies of patients.
Threatened by new 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.
Radiology Core
 Threats to core activities: competition from
cardiologists, orthopedists and others who want to
do imaging work (outside alternatives).

Threat to core assets: disruptive technology
that diminishes need for radiologists / imaging
studies / equipment or supplants our diagnostic
capability, e.g., teleradiology, CAD, genomics…
(diminished value).
Key Observations
 Radiology is successful!
 Success breeds complacency - BLUNTS
APPROPRIATE RESPONSE TO THREATS.
 Success breeds persistence in what we do well
(despite obvious threats), at the expense of
adaptability and innovation.
“This problem haunts us,
as we address economically motivated
self-referral and every other issue on which
we interface with the public.”
James P. Borgstede, M.D.
“The Public Face of Radiology”
(JACR, 2005)
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.
Statement 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. Office-based imaging services offer three important advantages
to patients. First, speeds correct diagnosis and treatment of the patient’s medical
condition. Second, in-office imaging is very convenient for the patient. The fact that their
physician is skilled in both the imaging aspect and physiology of their ailment increases
patient confidence as well. Finally, it reduces the number of billed encounters, thereby
reducing spending. The public needs to understand the extraordinary contributions of
diagnostic imaging to physicians’ ability to diagnose and treat illness quickly and accurately.”
http://www.acc.org/advocacy/advoc_issues/imaging_021005.htm
Developments In Our Technology
... “disruptive technology”
that has potential to
diminish need for or
visibility of radiologists,
e.g., teleradiology, CAD,
PACS….
Computer-aided detection (CAD)
mammogram
Rise Of The
Patient-Centered Medical Home
Model
 Momentum for reshaping the payment environment
around a primary care model “The Patient-Centered
Medical Home.”
 Policies that promote personal, holistic and
coordinated care for all will result in better value and
improved health.
Rise Of The
Patient-Centered Medical Home
Model
 Primary care/team care focused
 Patient-centered
 Being pursued by business community,
purchasers, payors and patient advocate
groups
Patient-centered Primary Care
Collaborative
Examples of Broad Stakeholder Support and Participation
AAMC Annual Meeting Nov 2008
Patient-Doctor Relationship
Patient-Centered PRIMARY CARE Collaborative:
“A long-term comprehensive relationship with your
personal physician empowered with the right tools and
linked to your care team can result in better overall family
health…”
AAMC Annual Meeting Nov 2008
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

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
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
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
Why We Should Be
Patient-centered
 We are physicians, professionals
 Maintenance of certification (MOC)
requirement
 We’ve been “invisible”
 Competition from other specialties
 Rendered anonymous by our own
technology
 Mainstream medicine’s Patient-Centered Medical Home
 What patients (and payors) want
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.
Lessons Patients Learn From
Talking With Radiologists

Radiologist as Imaging Expert,
Knowledgeable Physician

Radiologist as Patient Advocate

Radiologist as Gatekeeper

Radiologist as Referring
Physician
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.
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
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
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
What Radiologists
Need To Do
 Differentiate your practice
 Provide great local services
 Provide personal service
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

JCAHO accredited

Designated Magnet Hospital

Distinguished Hospital Award for clinical excellence and patient safety

338,000 imaging studies performed in 2008

386 radiology employees and 27 radiologists

7 outpatient imaging centers

State-of-the-art Breast Care Center
A Case Study
Accuracy Of Appointment

Correct exam scheduled?

Preparation given to patient?

Arrival time and exam time explained?

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

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

Radiologist speed

Workload

Number of radiologists on duty

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

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

Reduce bottlenecks

Apply same rigor to add-on and walk-in patients

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
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?
Radiology As Commodity:
Drivers

Consumer Driven Care

PACS/Teleradiology


o
CAD
o
Demystification of the technology
o
In-office clinician imaging
o
Corporatization of Radiology
Internal Factors
o
Volume per FTE: The Time/Money Dynamic
o
Lack of Sub-specialization
o
Nighthawk
o
Radiologist “Culture” (life style, entitlement mentality, addiction to pathological
democracy
Imaging services provider RadNet of Los Angeles has received a $110 million
loan from GE Healthcare Financial Services (Reported in January 2008)
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
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
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
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 you 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
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
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
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
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
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
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.