Transcript Patient-Centered Radiology

Patient-centered Radiology
Introducing
Sponsored by the
Patient-Centered Radiology Steering Committee
of the Radiological Society of North America
Rev 2014
Overview
 Are radiologists patient-centered?
 What does it mean for a Radiologist to be focused
on patients?
 How are Radiologists trying to become
patient-centered?
 How can Physicians help Radiologists be more
patient-centered… and how can you help?
 Discussion
Are Radiologists
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
The Doctor-Patient
Relationship
 Built on familiarity and trust
 The foundation of the place and influence of
physicians in society
 Not traditionally developed in radiology,
except for interventional services
Glazer GM, Ruiz JA. The State of Radiology in 2006: Very High Spatial Resolution but No Visibility.
Radiology. 2006; 241:11-16
Maintenance Of Certification (MOC)
Fulfills 3 of 6 competencies required
for MOC:

Interpersonal and communication skills

Patient care

Professionalism
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
 Core activities: activities that have
historically generated profits for the
industry; threatened by new outside
alternatives.*
o
For radiology:
the production, interpretation and distribution of quality imaging
studies of patients.
* McGahan AM. How Industries Change. Harvard Business Review. October 2004
Radiology Core
 Core assets: resources, knowledge, and
brand capital that have historically made the
organization unique; threatened by changes
that diminish value.*
o
For radiology:
independent, integrated subspecialty, whole body knowledge,
brand name, early access to “state-of-the-art” technology, visual
experience with in vivo pathology.
* McGahan AM. How Industries Change. Harvard Business Review. October 2004
Developments
In Our Technology
...“disruptive technology” that has
potential to diminish need for or
visibility of radiologists, e.g.,
teleradiology, CAD, PACS….
What Patients (And Others) Want
 Patient-centered care promoted by the 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

www.cahps.ahrq.gov

Health care quality information from the consumer
perspective

27-question survey developed and cleared for public use
January 2006

Data published beginning of 2008

ABMS incorporated CAHPS patient survey into MOC
standards
Some CAHPS Survey Topics
Relevant To Imaging
 Communication with doctors
 Communication with nurses
 Responsiveness of staff
 Discharge information
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
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
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
Radiologist As A
Patient-centered Physician
 We are physicians, professionals
 Maintenance of certification (MOC) requirement
 Can no longer afford to be “invisible”
 Rendered anonymous by our own technology
 Mainstream medicine’s Patient-Centered Medical Home
 What patients (and payors) want
What Does It Mean
For A Radiologist To Be Focused
on Patients?
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
Components:
Scheduling
Registration
Billing
Results
Reporting
PATIENT-CENTERED
EXPERIENCE
Reception
Caregiver
Interactions
http://www.hoaghospital.org/radiology/
Putting Patients First
 Minimize delays
 Increase communication
 Create a welcoming
environment of caring,
responsive people
How Are Radiologists Trying To
Become Patient-centered?
Being More Visible
 Meet and greet
 Discussing results
 Make the radiologistas-physician
connection with your patients
 Becoming a recognizable 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.
Radiologists Can Help Ease
Your Patients’ Concerns
 Direct communication with patient about:
The diagnostic process
o Purpose for the exam
o Radiation concerns
o Important finding
o
 Direct communication with you about:
o
Urgent or unexpected findings
Direct Communication
Of Results
 In some practices, radiologists can discuss
results of imaging studies directly with the patient
 Close communication between the radiologist
and the referring physician is needed for this
process to succeed
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
 Direct communication between the radiologist and
the patient allows the patient to ask questions and
may provide the radiologist with important historical
information
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
Abnormal Results
If you prefer to reveal abnormal results to your
patients personally:
 Develop a relationship with your local
radiologist
 Collaboratively create a script that allows the
radiologist to convey important findings in a
manner consistent with your patient’s needs
What Are Radiologists Doing To
Become More Patient-Centered?
And How Can You Help?
Improving Exam Scheduling
 Ensuring that the correct exam is scheduled
o
Requires good clinical information on the request
 Appropriate exam preparation instructions
o
Have your office staff ask about preps
 Explaining the timing of the exam
 Ensuring that physician orders are received
and correct
o
Lost or delayed orders result in patient dissatisfaction
Keeping Backlogs
To A Minimum
 Most centers try to accommodate patients
within 2 days
 Patient reminder calls
Turnaround Times
 Most radiology practices are monitoring time from order
to final report
 Technology has improved radiology report generation
o
PACS
o
Computer-based information systems
o
Voice recognition dictation
o
Standardized reporting
o
Urgent findings notification systems
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)
Risks Of Teleradiology
 Diminishes contact between the interpreting
radiologist and the patient
 May decrease your ability to know the
qualifications of the radiologist interpreting
your patient’s images
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
Take Advantage Of The Radiologist’s
Medical Imaging Expertise!
 Communicate with your radiologists
o
Find out about their special skills and practices
 Invite them to participate in multidisciplinary
conferences and rounds
 Call them for questions about:
o
o
o
appropriateness of exams
radiation safety
newly available imaging modalities and interventional
procedures
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
 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 pledge in support of patient-centered
practices (no monetary donations)
Resources At Your Fingertips:
 RadiologyInfo.org
Provides patients with easy-to-understand information about
radiologic tests, treatments and procedures
 ImageGently.org
Information about reducing radiation dose during imaging of
children
 ImageWisely.org
Information about reducing radiation dose during imaging
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 both in 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

Results

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
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.