2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 1/23

#JACR transcript

Healthcare Social Media TranscriptFrom: Thu Feb 26 9:00:00 PST 2015To: Thu Feb 26 10:15:00 PST 2015

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What is #JACR? Who were the influencers during this time period? #JACR analytics

Healthcare Conference ­ Healthcare Tweet Chats ­ Healthcare Analytics

jim_rawson_md RT @nxtstop1: Thanks to everyone for a wonderful chat ~ we'll talk this eve~ specialthanks to Jim Rawson~ off to #jacr , heartfelt best wi… Thu Feb 26 9:00:37 PST 2015

kristinahoque RT @MattHawkinsMD: More #JACR pre­reading ­­ http://t.co/n30nmZD7oZ ­­ High­deductible plans need reform. Thu Feb 26 9:00:42 PST 2015

ruthcarlosmd Hi, everyone! Welcome to #JACR tweet chat. Mark Fendrick MD @UM_VBID guestmod, talking about the ACA and value based insurance design. Thu Feb 26 9:00:57 PST 2015

bjh41647 #jacr Bruce here. Power out, getting cold, may run out of juice on the iPad. Don't worryabout me. Save yourselves Thu Feb 26 9:01:33 PST 2015

um_vbid @UM_VBID: #vbid one pager: http://t.co/7zzTRGMbCt #jacr Thu Feb 26 9:02:34 PST 2015

nxtstop1 @bjh41647 Hi Bruce~ omg, no power ~ save your battery power~ #jacr Thu Feb 26 9:02:41 PST 2015

matthawkinsmd RT @GRU_RAD: Thanks for joining #SHCRUSA chat. See you at #SHCR schooltomorrow. Now time for #JACR chat. Thu Feb 26 9:03:01 PST 2015

nxtstop1 @ruthcarlosmd @UM_VBID Hi Ruth~ lovely to be here with you and all~ #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 2/23

Thu Feb 26 9:03:07 PST 2015

ruthcarlosmd Please introduce yourselves as we get the chat started. #JACR Thu Feb 26 9:03:22 PST 2015

matthawkinsmd Matt joining from #ATL ­­ excited about this topic. #jacr Thu Feb 26 9:03:27 PST 2015

nxtstop1 @MattHawkinsMD Hi Matt, so nice to see you~ #jacr Thu Feb 26 9:03:46 PST 2015

jim_rawson_md Radiology chair at @GRU_RAD joining #jacr chat Thu Feb 26 9:04:21 PST 2015

um_vbid welcome all, happy to be here and answer any questions about #vbid #jacr Thu Feb 26 9:04:32 PST 2015

jim_rawson_md RT @bjh41647: #jacr Bruce here. Power out, getting cold, may run out of juice on theiPad. Don't worry about me. Save yourselves Thu Feb 26 9:04:33 PST 2015

kristinahoque Kristina ( #radres )here ­ tweeting from AIRP (great lectures by the way@RadiologyACR #JACR Thu Feb 26 9:04:38 PST 2015

drgmcginty @JACRJournal #jacr I'm on! Thu Feb 26 9:05:14 PST 2015

nxtstop1 Hello Everyone, Bernadette Keefe MD ~academic radiologist > now in independentwork , Chapel Hill NC under 6 inches of snow like Bruce #jacr Thu Feb 26 9:05:32 PST 2015

drgmcginty .@radiologyACR Econ Chair and breast Imager @weillcornell Geraldine here #jacr Thu Feb 26 9:06:07 PST 2015

nxtstop1 @KristinaHoque @RadiologyACR Hi Kristina~ nice to see you~ enjoy your lectures!#jacr Thu Feb 26 9:06:14 PST 2015

nxtstop1 @DrGMcGinty @RadiologyACR @WeillCornell Hi Geraldine~ lovely to see you~#jacr Thu Feb 26 9:06:33 PST 2015

kristinahoque @nxtstop1 glad to see you ­ stay warm and safe! #JACR Thu Feb 26 9:06:45 PST 2015

mightycasey Greetings all! #bcsm community member, WHO­tagged patient expert, #medx#epatient, #hospmed journo, patient­side thought leader. #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 3/23

Thu Feb 26 9:07:01 PST 2015

nxtstop1 @KristinaHoque @nxtstop1 Thank you and also Bruce Hillman ~ he has all that snowAND NO power #jacr Thu Feb 26 9:07:25 PST 2015

nxtstop1 @MightyCasey Hey Casey , nice to see you ~ #jacr Thu Feb 26 9:07:43 PST 2015

ruthcarlosmd T1: Designing insurance coverage more than "bigger benefit, bigger cost." Mustinclude effectiveness= high value, low cost services. #jacr Thu Feb 26 9:08:43 PST 2015

um_vbid #vbid basic premise set consumer cost­sharing on clinical value, not price of service.Good idea for radiology? #jacr Thu Feb 26 9:09:07 PST 2015

pfanderson Patricia from Michigan, joining #jacr a couple minutes late and multitasking while inmeeting Thu Feb 26 9:09:46 PST 2015

pfanderson RT @ruthcarlosmd: Hi, everyone! Welcome to #JACR tweet chat. Mark Fendrick MD@UM_VBID guest mod, talking about the ACA and value based ins… Thu Feb 26 9:10:03 PST 2015

mdaware HSeth Trueger, emergency physician at @UChicago #jacr Thu Feb 26 9:10:07 PST 2015

pfanderson RT @MattHawkinsMD: Pre­reading for the #JACR tchat ­­ http://t.co/5UTUNQzMlA ­­starting in 3 minutes. Thu Feb 26 9:10:14 PST 2015

pfanderson RT @UM_VBID: #VBID Infographic: https://t.co/rXz4xSfIJQ #jacr Thu Feb 26 9:10:25 PST 2015

nxtstop1 @ruthcarlosmd Are we on Question 1: What is clinical nuance and value basedinsurance design? #jacr Thu Feb 26 9:10:35 PST 2015

kristinahoque @UM_VBID sometimes we don't know the value until after the imaging is done ...#JACR Thu Feb 26 9:10:56 PST 2015

nxtstop1 @MDaware @UChicago Hi Seth ~ great to have you with us~ #jacr Thu Feb 26 9:11:10 PST 2015

matthawkinsmd @UM_VBID ­ It is a good idea for radiology ­­ particularly for some of the symptomsmentioned in #ImageWisely campaign. #JACR Thu Feb 26 9:11:24 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 4/23

radiologyacr RT @ruthcarlosmd: Hi, everyone! Welcome to #JACR tweet chat. Mark Fendrick MD@UM_VBID guest mod, talking about the ACA and value based ins… Thu Feb 26 9:11:30 PST 2015

drgmcginty @UM_VBID As long as using imaging appropriately and recognize downstreamvalue of imaging even if negative to reduce further costs #jacr Thu Feb 26 9:11:31 PST 2015

matthawkinsmd @KristinaHoque @UM_VBID ­­ And that, unfortunately is so commonly true. #JACR Thu Feb 26 9:11:53 PST 2015

um_vbid Coverage for CT­based lung cancer screening based on specific clinicalcharacteristics e.g. smoking hx? Example of #vbid in radiology. #jacr Thu Feb 26 9:11:59 PST 2015

jacrjournal RT @KristinaHoque: @UM_VBID sometimes we don't know the value until after theimaging is done ... #JACR Thu Feb 26 9:11:59 PST 2015

drgmcginty @pfanderson is there any other way to do these Tweetchats! #JACR Thu Feb 26 9:12:08 PST 2015

jacrjournal RT @ruthcarlosmd: T1: Designing insurance coverage more than "bigger benefit,bigger cost." Must include effectiveness= high value, low cos… Thu Feb 26 9:12:21 PST 2015

mightycasey @DrGMcGinty @RLI_ACR SUPER! #jacr #hcsm Thu Feb 26 9:12:27 PST 2015

pfanderson RT @nxtstop1: @ruthcarlosmd Are we on Question 1: What is clinical nuance andvalue based insurance design? #jacr Thu Feb 26 9:12:33 PST 2015

roguerad .@ruthcarlosmd radiologists need to decide if their primary value is decision making,efficiency or outcomes. Agrippas's Trilemma #JACR Thu Feb 26 9:12:37 PST 2015

kristinahoque @DrGMcGinty @UM_VBID completely agree ­ a systematic approach is key #JACR Thu Feb 26 9:12:42 PST 2015

matthawkinsmd The other item we haven't ever addressed is the value of "normal" ­­ So often aradiologist's value is inherent in confirming normalcy #JACR Thu Feb 26 9:12:46 PST 2015

mdaware @KristinaHoque @UM_VBID #jacr and we've already seen heavy­handed P4Pmeasures like OP15... Thu Feb 26 9:12:47 PST 2015

um_vbid @nxtstop1 clinical nuance and #vbid defined on our info graphic: Infographic:

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 5/23

https://t.co/rXz4xSfIJQ #jacr Thu Feb 26 9:12:59 PST 2015

pfanderson @UM_VBID With so many cases of lung cancer w/o smoking history, how does thatwork? #jacr Thu Feb 26 9:13:21 PST 2015

drgmcginty @UM_VBID yes and gr8 example of building in quality metrics and outcomestracking.Now working with @CMSGov on the payment policy #JACR Thu Feb 26 9:13:31 PST 2015

kristinahoque RT @MattHawkinsMD: The other item we haven't ever addressed is the value of"normal" ­­ So often a radiologist's value is inherent in confi… Thu Feb 26 9:13:47 PST 2015

mdaware RT @MattHawkinsMD: The other item we haven't ever addressed is the value of"normal" ­­ So often a radiologist's value is inherent in confi… Thu Feb 26 9:13:52 PST 2015

mightycasey T1a: Here's a disruptive suggestion ­ how about COST info on ICD codes in EHRs?Why not serve up $$ info at point of care that way? #jacr Thu Feb 26 9:13:54 PST 2015

matthawkinsmd RT @RogueRad: .@ruthcarlosmd radiologists need to decide if their primary value isdecision making, efficiency or outcomes. Agrippas's Tril… Thu Feb 26 9:13:55 PST 2015

pfanderson @DrGMcGinty At night, at home, with dog in lap and kids watching the telly ;) #jacr Thu Feb 26 9:14:02 PST 2015

roguerad All measures of value have trade offs. #JACR Thu Feb 26 9:14:10 PST 2015

drgmcginty @RogueRad can we stop with the historical references? My reading list for our Aprildebate is long enough! @ruthcarlosmd #JACR Thu Feb 26 9:14:15 PST 2015

kristinahoque @MattHawkinsMD this is a key point ­ often "normal" brings the biggest cost savingvalue #JACR Thu Feb 26 9:14:21 PST 2015

nxtstop1 RT @RogueRad: .@ruthcarlosmd radiologists need to decide if their primary value isdecision making, efficiency or outcomes. Agrippas's Tril… Thu Feb 26 9:14:25 PST 2015

kristinahoque RT @DrGMcGinty: @UM_VBID yes and gr8 example of building in quality metrics andoutcomes tracking.Now working with @CMSGov on the payment p… Thu Feb 26 9:14:41 PST 2015

ukifteam RT @RogueRad: .@ruthcarlosmd radiologists need to decide if their primary value is

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 6/23

decision making, efficiency or outcomes. Agrippas's Tril… Thu Feb 26 9:15:00 PST 2015

rhwiggins RT @ruthcarlosmd: Hi, everyone! Welcome to #JACR tweet chat. Mark Fendrick MD@UM_VBID guest mod, talking about the ACA and value based ins… Thu Feb 26 9:15:07 PST 2015

rhwiggins RT @MattHawkinsMD: The other item we haven't ever addressed is the value of"normal" ­­ So often a radiologist's value is inherent in confi… Thu Feb 26 9:15:13 PST 2015

jacrjournal RT @MattHawkinsMD: The other item we haven't ever addressed is the value of"normal" ­­ So often a radiologist's value is inherent in confi… Thu Feb 26 9:15:17 PST 2015

radiologyacr RT @RogueRad: .@ruthcarlosmd radiologists need to decide if their primary value isdecision making, efficiency or outcomes. Agrippas's Tril… Thu Feb 26 9:15:36 PST 2015

roguerad Trade offs mean you need to decide what's important & what's importanter & to whom.#JACR Thu Feb 26 9:15:39 PST 2015

matthawkinsmd @pfanderson @UM_VBID ­­ Its a valid question. http://t.co/N8LksqXeiu #JACR Thu Feb 26 9:15:53 PST 2015

mdaware my concern with #VBID is that we'll just end up with another RUC #jacr Thu Feb 26 9:16:15 PST 2015

jacrjournal RT @RogueRad: All measures of value have trade offs. #JACR Thu Feb 26 9:16:17 PST 2015

roguerad RT @MDaware: my concern with #VBID is that we'll just end up with another RUC#jacr Thu Feb 26 9:16:37 PST 2015

mightycasey +100000 => RT @RogueRad: All measures of value have trade offs. #JACR Thu Feb 26 9:16:38 PST 2015

jim_rawson_md Still fun & educational in any format RT@DrGMcGinty: @pfanderson is there anyother way to do these Tweetchats! #JACR Thu Feb 26 9:17:00 PST 2015

drpepperdavid RT @RogueRad: .@ruthcarlosmd radiologists need to decide if their primary value isdecision making, efficiency or outcomes. Agrippas's Tril… Thu Feb 26 9:17:10 PST 2015

mightycasey Big risk here, VERY scary => RT @MDaware: my concern with #VBID is that we'll justend up with another RUC #jacr Thu Feb 26 9:17:10 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 7/23

ruthcarlosmd @MightyCasey cost transparency great if paired w/ benefit plan deets. my out­of­pocket HDHP costs are not your PPO in­network costs. #JACR Thu Feb 26 9:17:27 PST 2015

um_vbid @pfanderson #vbid doesn't determine coverage. removes barriers to those services &populations where evidence is best. #jacr Thu Feb 26 9:17:32 PST 2015

jacrjournal RT @RogueRad: Trade offs mean you need to decide what's important & what'simportanter & to whom. #JACR Thu Feb 26 9:17:40 PST 2015

jim_rawson_md @RogueRad @ruthcarlosmd Can we optimize more than one? #JACR Thu Feb 26 9:17:46 PST 2015

mdaware or just a few large strata of cost sharing, ie insufficient nuance #jacr Thu Feb 26 9:17:46 PST 2015

ajmc_journal RT @UM_VBID: @pfanderson #vbid doesn't determine coverage. removes barriers tothose services & populations where evidence is best. #jacr Thu Feb 26 9:18:19 PST 2015

matthawkinsmd @MDaware ­ Exactly. Valuation of medical services as deemed by limited evidence &some chosen individuals. Need to avoid that fate. #JACR Thu Feb 26 9:18:31 PST 2015

drgmcginty @MDaware The RUC assesses relativity not societal or personal health value interms of outcomes, the V in rVu is a little confusing #jacr Thu Feb 26 9:18:48 PST 2015

rhwiggins @ruthcarlosmd rick wiggins, UUHSC hi! #JACR Thu Feb 26 9:18:54 PST 2015

jim_rawson_md Critical question: Value to who? RT@RogueRad: All measures of value have tradeoffs. #JACR Thu Feb 26 9:19:18 PST 2015

kristinahoque RT @MattHawkinsMD: @MDaware ­ Exactly. Valuation of medical services asdeemed by limited evidence & some chosen individuals. Need to avoid… Thu Feb 26 9:19:23 PST 2015

um_vbid @MDaware we really do not believe that current one­size­fits­all cost­sharing forradiology is a better model than clinical nuance. #jacr Thu Feb 26 9:19:42 PST 2015

mdaware @DrGMcGinty but those societal and health values need to be set. by who? with whatentrenched interests? #jacr Thu Feb 26 9:19:45 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 8/23

mightycasey @DrGMcGinty @chcosts Said to Karen Ignani @AHIPCoverage that ins $$ data @point of care are necessary. She agrees. Now what? #jacr #hcpt Thu Feb 26 9:19:47 PST 2015

mdaware @UM_VBID me neither! status quo is certainly far from optimal #jacr Thu Feb 26 9:20:15 PST 2015

matthawkinsmd @DrGMcGinty @MDaware ­­ Well stated. #JACR Thu Feb 26 9:20:27 PST 2015

mightycasey @ruthcarlosmd Very true. Why POC $$ data should be served up as THATPATIENT'S actual benefit. It's possible. Why isn't it practice? #jacr Thu Feb 26 9:20:42 PST 2015

matthawkinsmd RT @UM_VBID: @MDaware we really do not believe that current one­size­fits­allcost­sharing for radiology is a better model than clinical nu… Thu Feb 26 9:20:49 PST 2015

kristinahoque @Jim_Rawson_MD @RogueRad #JACR defining the key stakeholders in value iscritical! Thu Feb 26 9:20:50 PST 2015

aliradmanmd RT @RogueRad: All measures of value have trade offs. #JACR Thu Feb 26 9:21:18 PST 2015

bjh41647 #JACR always the question. Who minds the minders? Thu Feb 26 9:21:49 PST 2015

drgmcginty @MDaware agree. Can I choose a plan that conforms to MY definition of value#personalizedmedicine #jacr and is that practical Thu Feb 26 9:21:57 PST 2015

mightycasey My suggestion re EHR/$$ tie in for point of care addresses both clinical nuance ANDplan design. IMO, at least. #jacr Thu Feb 26 9:22:02 PST 2015

um_vbid @MightyCasey we agree that cost­sharing is essential but patient contribution shouldbe based not on price, but on clinical value #jacr Thu Feb 26 9:22:28 PST 2015

radiologyacr RT @RogueRad: Trade offs mean you need to decide what's important & what'simportanter & to whom. #JACR Thu Feb 26 9:22:32 PST 2015

aribfriedman RT @MDaware: my concern with #VBID is that we'll just end up with another RUC#jacr Thu Feb 26 9:23:41 PST 2015

aribfriedman RT @MDaware: @DrGMcGinty but those societal and health values need to be set.by who? with what entrenched interests? #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 9/23

Thu Feb 26 9:23:48 PST 2015

um_vbid @DrGMcGinty #vbid plans have been widely implemented. clinical and financialevidence growing. http://t.co/MeYpm4OUXY #jacr Thu Feb 26 9:23:48 PST 2015

pfanderson @UM_VBID So there is more evidence for smokers than non­smokers, I assume?#jacr Thu Feb 26 9:23:49 PST 2015

aribfriedman RT @DrGMcGinty: @MDaware agree. Can I choose a plan that conforms to MYdefinition of value #personalizedmedicine #jacr and is that practi… Thu Feb 26 9:23:52 PST 2015

nulall RT @UM_VBID: @MightyCasey we agree that cost­sharing is essential but patientcontribution should be based not on price, but on clinical va… Thu Feb 26 9:24:14 PST 2015

mightycasey @UM_VBID Agree completely, but shared decision making CANNOT. HAPPEN.without cost data served up w/TX options. #sdm #s4pm #gmdd #jacr Thu Feb 26 9:24:17 PST 2015

pfanderson RT @DrGMcGinty: @MDaware agree. Can I choose a plan that conforms to MYdefinition of value #personalizedmedicine #jacr and is that practi… Thu Feb 26 9:24:27 PST 2015

nxtstop1 MT @DrGMcGinty: @MDaware agree. Can I choose a plan that conforms to MYdefinition of value #personalizedmedicine #jacr & is that practical Thu Feb 26 9:24:43 PST 2015

um_vbid @pfanderson yes, but we don't create the evidence, we utilize the best available.#jacr Thu Feb 26 9:25:08 PST 2015

nxtstop1 RT @MightyCasey: @UM_VBID Agree completely, but shared decision makingCANNOT. HAPPEN. without cost data served up w/TX options. #sdm #s4pm… Thu Feb 26 9:25:11 PST 2015

ruthcarlosmd T2: How do you apply value­based insurance design to imaging care? #jacr Thu Feb 26 9:25:20 PST 2015

pfanderson @DrGMcGinty @MDaware Tricky. I've heard some people ask if provided caredoesn't match expected value, can they be reimbursed. #jacr Thu Feb 26 9:25:26 PST 2015

bjh41647 #JACR how determine value? Some say count positive tests. Seems crazy Thu Feb 26 9:25:27 PST 2015

personal_med RT @nxtstop1: MT @DrGMcGinty: @MDaware agree. Can I choose a plan thatconforms to MY definition of value #personalizedmedicine #jacr & is… Thu Feb 26 9:25:45 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 10/23

jim_rawson_md RT@bjh41647: #JACR always the question. Who minds the minders? Thu Feb 26 9:25:54 PST 2015

pfanderson RT @UM_VBID: @DrGMcGinty #vbid plans have been widely implemented. clinicaland financial evidence growing. http://t.co/MeYpm4OUXY #jacr Thu Feb 26 9:26:03 PST 2015

pfanderson RT @UM_VBID: @MightyCasey we agree that cost­sharing is essential but patientcontribution should be based not on price, but on clinical va… Thu Feb 26 9:26:11 PST 2015

drgmcginty @ruthcarlosmd Well scientifically supported screening for breast and lung cancer withno cost sharing is a good start! #JACR Thu Feb 26 9:26:22 PST 2015

pfanderson RT @bjh41647: #JACR how determine value? Some say count positive tests. Seemscrazy Thu Feb 26 9:26:28 PST 2015

matthawkinsmd @UM_VBID ­ How will asymmetry of information be handled when some physiciansencourage clinically useless tests? Will pts pay more? #JACR Thu Feb 26 9:26:28 PST 2015

mightycasey @UM_VBID And, BTW, I'm not talking cost­sharing at all. I'm talking well upstreamfrom that decision: WTF *are* costs in 1st place? #jacr Thu Feb 26 9:26:50 PST 2015

nxtstop1 RT @MattHawkinsMD: @UM_VBID ­ How will asymmetry of information be handledwhen some physicians encourage clinically useless tests? Will pt… Thu Feb 26 9:26:55 PST 2015

um_vbid @MightyCasey agree. cost­related non adherence big problem in public and privatepayers. Transparency crucial http://t.co/MtJA0u9zLe #jacr Thu Feb 26 9:26:57 PST 2015

jacrjournal RT @ruthcarlosmd: T2: How do you apply value­based insurance design to imagingcare? #jacr Thu Feb 26 9:27:25 PST 2015

drgmcginty .@bjh41647 that is crazy, gotta do negative CT in the ED to reduce exploratorylaparotomy rates #JACR Thu Feb 26 9:27:29 PST 2015

nulall @ruthcarlosmd We need more data to define value of imaging studies, like the greatwork being done by @NeimanHPI #jacr Thu Feb 26 9:27:40 PST 2015

matthawkinsmd @MightyCasey @UM_VBID ­­ Agree, Casey. But the cost of diagnosis (vs treatment)is less clear. #JACR Thu Feb 26 9:28:00 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 11/23

nxtstop1 @MattHawkinsMD @UM_VBID T2 yup~ patients will pay more>>this is where#radiology can get stung. Reviled by one side or the other~ #jacr Thu Feb 26 9:28:02 PST 2015

bjh41647 T2 #jacr in absence of true "value" need proxies. Impact on care, days not working,wolf, etc Thu Feb 26 9:28:03 PST 2015

mightycasey @MattHawkinsMD @UM_VBID Where expert #epatients like me and my 100,000friends come in: teaching peer­to­peer system literacy. #jacr Thu Feb 26 9:28:09 PST 2015

matthawkinsmd @MightyCasey @UM_VBID ­­ Sadly we have no idea how much it costs to diagnoseanything. #JACR Thu Feb 26 9:28:22 PST 2015

drgmcginty .@MattHawkinsMD @UM_VBID #decisionsupport is our chance to influence that as#radiologists #jacr Thu Feb 26 9:28:26 PST 2015

kristinahoque RT @NULall: @ruthcarlosmd We need more data to define value of imaging studies,like the great work being done by @NeimanHPI #jacr Thu Feb 26 9:28:35 PST 2015

drgmcginty RT @NULall: @ruthcarlosmd We need more data to define value of imaging studies,like the great work being done by @NeimanHPI #jacr Thu Feb 26 9:28:36 PST 2015

joshgray_hit RT @UM_VBID: @MightyCasey we agree that cost­sharing is essential but patientcontribution should be based not on price, but on clinical va… Thu Feb 26 9:28:50 PST 2015

um_vbid @MightyCasey agree costs are complicated. #vbid focuses on consumer­notaggregate­cost of service. Consumers respond to price signals #jacr Thu Feb 26 9:28:55 PST 2015

pfanderson @UM_VBID Interesting. Surely some of the activities or participants funnel data thatsupport research? #jacr Thu Feb 26 9:28:58 PST 2015

pfanderson RT @MattHawkinsMD: @UM_VBID ­ How will asymmetry of information be handledwhen some physicians encourage clinically useless tests? Will pt… Thu Feb 26 9:29:31 PST 2015

kristinahoque RT @DrGMcGinty: .@MattHawkinsMD @UM_VBID #decisionsupport is our chance toinfluence that as #radiologists #jacr Thu Feb 26 9:29:31 PST 2015

ajmc_journal RT @UM_VBID: @MightyCasey agree. cost­related non adherence big problem inpublic and private payers. Transparency crucial http://t.co/MtJA…

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 12/23

Thu Feb 26 9:29:38 PST 2015

mightycasey @UM_VBID All discussions that include words "compliance" + "adherence" w/outincluding individual patient's values/goals = #epicfail #jacr Thu Feb 26 9:29:53 PST 2015

pfanderson RT @UM_VBID: @MightyCasey agree. cost­related non adherence big problem inpublic and private payers. Transparency crucial http://t.co/MtJA… Thu Feb 26 9:30:24 PST 2015

nulall @DrGMcGinty @MattHawkinsMD @UM_VBID Agree. Decision support &Appropriateness are our best proxies to true $ value. #jacr Thu Feb 26 9:30:25 PST 2015

nxtstop1 http://t.co/JgRA8LfhrN 1970s. MT @)DrGMcGinty: .@bjh41647 yes, is crazy>neednegative CT in ED to reduce exploratory laparotomy rates #JACR” Thu Feb 26 9:30:30 PST 2015

kristinahoque #JACR we need to work this paradigm shift into residency training so #radres areready Thu Feb 26 9:30:40 PST 2015

matthawkinsmd RT @DrGMcGinty: .@MattHawkinsMD @UM_VBID #decisionsupport is our chance toinfluence that as #radiologists #jacr Thu Feb 26 9:31:03 PST 2015

matthawkinsmd @DrGMcGinty @UM_VBID ­­ Couldn't agree more. #JACR Thu Feb 26 9:31:14 PST 2015

jacrjournal RT @NULall: @ruthcarlosmd We need more data to define value of imaging studies,like the great work being done by @NeimanHPI #jacr Thu Feb 26 9:31:28 PST 2015

drgmcginty RT @NULall: @DrGMcGinty @MattHawkinsMD @UM_VBID Agree. Decision support& Appropriateness are our best proxies to true $ value. #jacr Thu Feb 26 9:31:39 PST 2015

bjh41647 @NULall @DrGMcGinty @MattHawkinsMD @UM_VBID #jacr may be asking to muchof AC. Limits to what we can claim Thu Feb 26 9:32:07 PST 2015

um_vbid @MattHawkinsMD hopeful that initiatives like choosing wisely will bring attention toservices of little/no value and sometimes harm. #jacr Thu Feb 26 9:32:12 PST 2015

mightycasey RT @NULall: Agree. Decision support & Appropriateness are our best proxies to true$ value. #jacr Thu Feb 26 9:32:12 PST 2015

radiologyacr RT @DrGMcGinty: .@MattHawkinsMD @UM_VBID #decisionsupport is our chance toinfluence that as #radiologists #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 13/23

Thu Feb 26 9:32:32 PST 2015

roguerad @jim_rawson_md @ruthcarlosmd In a trilemma you are allowed 2/3, not all 3! #JACRThu Feb 26 9:32:40 PST 2015

marthaabernathy RT @MightyCasey: @UM_VBID All discussions that include words "compliance" +"adherence" w/out including individual patient's values/goals =… Thu Feb 26 9:32:54 PST 2015

nxtstop1 Essential>TY 4 mentioning @KristinaHoque: #JACR we need to work this paradigmshift into residency training so #radres are ready” cc @hjluks Thu Feb 26 9:32:54 PST 2015

rhwiggins @bjh41647 #JACR hopefully EBM &value directed focuses will finally get imagers tofocus on getting the case right rather than reading faster Thu Feb 26 9:33:11 PST 2015

nulall @bjh41647 @DrGMcGinty @MattHawkinsMD @UM_VBID Very true, but ourknowledge of value is limited, so have to do best with what we have #jacr Thu Feb 26 9:33:18 PST 2015

bjh41647 @KristinaHoque #jacr absolutely. Teach referring docs how to consult, not order Thu Feb 26 9:33:27 PST 2015

kristinahoque RT @UM_VBID: @MattHawkinsMD hopeful that initiatives like choosing wisely willbring attention to services of little/no value and sometimes… Thu Feb 26 9:33:40 PST 2015

pfanderson RT @MightyCasey: RT @NULall: Agree. Decision support & Appropriateness are ourbest proxies to true $ value. #jacr Thu Feb 26 9:33:44 PST 2015

economeer @DrGMcGinty @bjh41647 #JACR Hard to determine value of imaging when thereare no good metrics for value of medical care Thu Feb 26 9:33:59 PST 2015

pfanderson RT @MightyCasey: @UM_VBID All discussions that include words "compliance" +"adherence" w/out including individual patient's values/goals =… Thu Feb 26 9:34:02 PST 2015

um_vbid @MightyCasey @jacr has the radiology community taken a lead role in supportingdecision support in CT lung cancer screenings? #jacr Thu Feb 26 9:34:03 PST 2015

mdaware RT @UM_VBID: @MightyCasey @jacr has the radiology community taken a lead rolein supporting decision support in CT lung cancer screenings? … Thu Feb 26 9:34:29 PST 2015

ruthcarlosmd RT @rhwiggins: @bjh41647 #JACR hopefully EBM &value directed focuses willfinally get imagers to focus on getting the case right rather tha… Thu Feb 26 9:34:39 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 14/23

bjh41647 RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:34:45 PST 2015

matthawkinsmd RT @rhwiggins: @bjh41647 #JACR hopefully EBM &value directed focuses willfinally get imagers to focus on getting the case right rather tha… Thu Feb 26 9:34:45 PST 2015

ruthcarlosmd RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:34:51 PST 2015

nulall RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:34:53 PST 2015

kristinahoque @bjh41647 absolutely ­need to train #radres and residents in other fields so the nextgeneration can lead the change #JACR Thu Feb 26 9:35:26 PST 2015

nxtstop1 Cultivate mutual understanding re med practice. @bjh41647: @KristinaHoque #jacrabsolutely. Teach referring docs how to consult, not order” Thu Feb 26 9:35:35 PST 2015

mdaware RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:35:41 PST 2015

radiologyacr RT @bjh41647: @KristinaHoque #jacr absolutely. Teach referring docs how toconsult, not order Thu Feb 26 9:36:41 PST 2015

um_vbid @economeer hard to argue on some existing evidence­based metrics (USPSTF)#vbid uses low­hanging fruit. need radiology examples. #jacr Thu Feb 26 9:36:56 PST 2015

nulall @economeer @DrGMcGinty @bjh41647 At least we can to some extent quantify howwe can reduce downstream costs (surgery, length of stay…) #jacr Thu Feb 26 9:36:59 PST 2015

pfanderson RT @bjh41647: @KristinaHoque #jacr absolutely. Teach referring docs how toconsult, not order Thu Feb 26 9:37:14 PST 2015

radiologyacr RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:37:19 PST 2015

pfanderson @bjh41647 @KristinaHoque And visa versa Consulting should go both directions,perhaps? #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 15/23

Thu Feb 26 9:37:41 PST 2015

mightycasey @UM_VBID @jacr IMO they have, but I'm an outside observer/fan, not a practitioner.#jacr Thu Feb 26 9:37:45 PST 2015

economeer RT @DrGMcGinty: .@MattHawkinsMD @UM_VBID #decisionsupport is our chance toinfluence that as #radiologists #jacr Thu Feb 26 9:37:47 PST 2015

ruthcarlosmd RT @UM_VBID: @economeer hard to argue on some existing evidence­basedmetrics (USPSTF) #vbid uses low­hanging fruit. need radiology exampl… Thu Feb 26 9:37:49 PST 2015

economeer RT @bjh41647: #JACR how determine value? Some say count positive tests. Seemscrazy Thu Feb 26 9:38:04 PST 2015

pfanderson RT @UM_VBID: @economeer hard to argue on some existing evidence­basedmetrics (USPSTF) #vbid uses low­hanging fruit. need radiology exampl… Thu Feb 26 9:38:04 PST 2015

mightycasey @economeer @bjh41647 @MattHawkinsMD @UM_VBID Hey, it's a process. I don'thave all the answers, I ask questions (journo) to find 'em. #jacr Thu Feb 26 9:38:32 PST 2015

bjh41647 @NULall @economeer @DrGMcGinty #jacr best is not to unneeded exam. Then nodownstream cost to worry about Thu Feb 26 9:38:33 PST 2015

mightycasey COMPLETELY crazy, IMO => RT @bjh41647: #JACR how determine value? Somesay count positive tests. Seems crazy Thu Feb 26 9:39:09 PST 2015

kristinahoque @pfanderson @bjh41647 absolutely ­ consulting should always be mutual #JACR Thu Feb 26 9:40:32 PST 2015

ruthcarlosmd T3: How does steerage to lower­cost providers or narrow networks affect patients andradiologists? How can radiologists respond? #JACR Thu Feb 26 9:40:34 PST 2015

chcosts @MightyCasey @DrGMcGinty @AHIPCoverage #jacr #hcpt Free the data. Now. All ofit. Thu Feb 26 9:41:01 PST 2015

economeer RT @UM_VBID: @economeer hard to argue on some existing evidence­basedmetrics (USPSTF) #vbid uses low­hanging fruit. need radiology exampl… Thu Feb 26 9:41:10 PST 2015

mightycasey RT @chcosts: @MightyCasey @DrGMcGinty @AHIPCoverage #jacr #hcpt Free thedata. Now. All of it.

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 16/23

Thu Feb 26 9:41:32 PST 2015

imagescribbler RT @bjh41647: @KristinaHoque #jacr absolutely. Teach referring docs how toconsult, not order Thu Feb 26 9:41:52 PST 2015

um_vbid @ruthcarlosmd until radiology community steps forward in demonstrating clinicalvalue, payers will turn to lowest cost options. #jacr Thu Feb 26 9:42:02 PST 2015

nxtstop1 T2 Initial value of radiology was to answer questions emanating from confusingclinical exam. Now done in lieu of=an issue & expensive #jacr Thu Feb 26 9:42:07 PST 2015

imagescribbler RT @DrGMcGinty: @MDaware agree. Can I choose a plan that conforms to MYdefinition of value #personalizedmedicine #jacr and is that practi… Thu Feb 26 9:42:21 PST 2015

mightycasey +1000 RT @UM_VBID: until radiology community steps forward in demonstratingclinical value, payers will turn to lowest cost options. #jacr Thu Feb 26 9:42:27 PST 2015

nulall RT @UM_VBID: @ruthcarlosmd until radiology community steps forward indemonstrating clinical value, payers will turn to lowest cost options… Thu Feb 26 9:42:29 PST 2015

imagescribbler RT @RogueRad: Trade offs mean you need to decide what's important & what'simportanter & to whom. #JACR Thu Feb 26 9:42:42 PST 2015

pfanderson RT @chcosts: @MightyCasey @DrGMcGinty @AHIPCoverage #jacr #hcpt Free thedata. Now. All of it. Thu Feb 26 9:42:50 PST 2015

pfanderson RT @MightyCasey: +1000 RT @UM_VBID: until radiology community steps forwardin demonstrating clinical value, payers will turn to lowest cos… Thu Feb 26 9:43:21 PST 2015

mightycasey T2 speaks directly to need to end "defensive medicine" IMO. Leverage #epatient peernetworks to drive system literacy. #s4pm #jacr Thu Feb 26 9:43:29 PST 2015

kristinahoque @ruthcarlosmd #JACR this is the key of the Imaging 3.0 campaign ­ each radiologistmust be an indispensable member of the team Thu Feb 26 9:43:40 PST 2015

ruthcarlosmd RT @UM_VBID: @ruthcarlosmd until radiology community steps forward indemonstrating clinical value, payers will turn to lowest cost options… Thu Feb 26 9:43:53 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 17/23

nxtstop1 T3 Very concerned re variation in quality of #radiology imaging esp w/regard 2 nonradiologists w/imaging capability,but some rads too #jacr Thu Feb 26 9:44:20 PST 2015

bjh41647 @UM_VBID @ruthcarlosmd #jacr inevitable. Possibly even if we show value. Peopleuse "value" to obscure that they mean cost (to them) Thu Feb 26 9:44:30 PST 2015

drgmcginty @MightyCasey @UM_VBID You are so right, we have to tell the story of what #quality#imaging means and costs #JACR Thu Feb 26 9:44:33 PST 2015

jacrjournal RT @KristinaHoque: @ruthcarlosmd #JACR this is the key of the Imaging 3.0campaign ­ each radiologist must be an indispensable member of th… Thu Feb 26 9:44:41 PST 2015

jacrjournal RT @MightyCasey: T2 speaks directly to need to end "defensive medicine" IMO.Leverage #epatient peer networks to drive system literacy. #s4… Thu Feb 26 9:44:51 PST 2015

radiologyacr RT @KristinaHoque: @ruthcarlosmd #JACR this is the key of the Imaging 3.0campaign ­ each radiologist must be an indispensable member of th… Thu Feb 26 9:44:57 PST 2015

drgmcginty RT @KristinaHoque: @ruthcarlosmd #JACR this is the key of the Imaging 3.0campaign ­ each radiologist must be an indispensable member of th… Thu Feb 26 9:45:10 PST 2015

jacrjournal RT @chcosts: @MightyCasey @DrGMcGinty @AHIPCoverage #jacr #hcpt Free thedata. Now. All of it. Thu Feb 26 9:45:15 PST 2015

kristinahoque RT @DrGMcGinty: @MightyCasey @UM_VBID You are so right, we have to tell thestory of what #quality #imaging means and costs #JACR Thu Feb 26 9:45:39 PST 2015

jacrjournal RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:46:06 PST 2015

economeer @ruthcarlosmd #JACR Q: Will this push prices down for all or drive prices up innarrow networks over time bc of capacity constraints? Thu Feb 26 9:46:18 PST 2015

bjh41647 @nxtstop1 #JACR not sure about PE. May be too non­specific. Perhaps biggest FPproblem causing downstream costs Thu Feb 26 9:46:24 PST 2015

nxtstop1 T3 With health insurance scrutinizing multiple similar exams,crucial that the first exambe the best> may be only & always the control #jacr Thu Feb 26 9:46:31 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 18/23

matthawkinsmd @nxtstop1 ­ The cheaper test interpreted as "needs f/u" is more expensive than the"higher cost" study interpreted as normal. #JACR Thu Feb 26 9:46:36 PST 2015

arjunsharmarad RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:46:49 PST 2015

mdaware RT @MattHawkinsMD: @nxtstop1 ­ The cheaper test interpreted as "needs f/u" ismore expensive than the "higher cost" study interpreted as no… Thu Feb 26 9:46:54 PST 2015

pfanderson RT @MightyCasey: T2 speaks directly to need to end "defensive medicine" IMO.Leverage #epatient peer networks to drive system literacy. #s4… Thu Feb 26 9:47:05 PST 2015

jacrjournal RT @NULall: @bjh41647 @DrGMcGinty @MattHawkinsMD @UM_VBID Very true,but our knowledge of value is limited, so have to do best with what we… Thu Feb 26 9:47:05 PST 2015

pfanderson @MightyCasey "Defensive medicine" is an oxymoron of sorts #jacr Thu Feb 26 9:47:45 PST 2015

jacrjournal RT @DrGMcGinty: @MightyCasey @UM_VBID You are so right, we have to tell thestory of what #quality #imaging means and costs #JACR Thu Feb 26 9:47:45 PST 2015

kristinahoque RT @MattHawkinsMD: @nxtstop1 ­ The cheaper test interpreted as "needs f/u" ismore expensive than the "higher cost" study interpreted as no… Thu Feb 26 9:48:00 PST 2015

mightycasey @shelleyvadams @AHIPCoverage I am on a committee w/Karen Agnani thru the endof May. Trust me, I'm ALL OVER THIS. #hcpt #jacr Thu Feb 26 9:48:11 PST 2015

um_vbid @economeer several specialties have aggressively addressed their "valueproposition" as we move from volume to value. #changeordie? #jacr Thu Feb 26 9:48:33 PST 2015

mdaware RT @UM_VBID: @economeer several specialties have aggressively addressed their"value proposition" as we move from volume to value. #chan… Thu Feb 26 9:48:48 PST 2015

bjh41647 @MattHawkinsMD @nxtstop1 #jacr agree. Need large scale studies showingcorrectness for 10­15 key indications. Big volume, big cost Thu Feb 26 9:48:52 PST 2015

roguerad I'd consider a radiologist who hedges incontinently a low value provider. #JACR Thu Feb 26 9:48:58 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 19/23

pfanderson RT @economeer: @ruthcarlosmd #JACR Q: Will this push prices down for all or driveprices up in narrow networks over time bc of capacity con… Thu Feb 26 9:49:22 PST 2015

nxtstop1 @MattHawkinsMD @nxtstop1 Precisely. But unless discerned ahead ~ the patient willpay out of pocket for that high quality 2nd exam~ #jacr Thu Feb 26 9:49:37 PST 2015

um_vbid @economeer In a clinically nuanced system clinicians paid for health produced ­ notprice of service. Better than capitation? #jacr Thu Feb 26 9:49:40 PST 2015

roguerad Value of radiologist ­ Value of Information ­ Reduce bandwidth of possibilities #JACR Thu Feb 26 9:50:04 PST 2015

mightycasey @pfanderson Practicing w/1 eye on the patient, other over shoulder looking forlawyers. Can go blind that way. #jacr http://t.co/g0m5aBEypH Thu Feb 26 9:50:11 PST 2015

jacrjournal RT @nxtstop1: T3 With health insurance scrutinizing multiple similar exams,crucialthat the first exam be the best> may be only & always th… Thu Feb 26 9:50:37 PST 2015

roguerad Embracing risk also adds value #JACR Thu Feb 26 9:50:44 PST 2015

nxtstop1 RT @bjh41647: @MattHawkinsMD @nxtstop1 #jacr agree. Need large scale studiesshowing correctness for 10­15 key indications. Big volume, big… Thu Feb 26 9:50:50 PST 2015

matthawkinsmd @RogueRad ­­ Ahh, lower value yes, but lower cost ­­ also yes. #JACR Thu Feb 26 9:50:59 PST 2015

pfanderson RT @MightyCasey: @pfanderson Practicing w/1 eye on the patient, other overshoulder looking for lawyers. Can go blind that way. #jacr http:… Thu Feb 26 9:51:03 PST 2015

bjh41647 RT @MightyCasey: @pfanderson Practicing w/1 eye on the patient, other overshoulder looking for lawyers. Can go blind that way. #jacr http:… Thu Feb 26 9:51:10 PST 2015

um_vbid @MattHawkinsMD Agree. We have long said that the most expensive therapy is theone that does not work. #howmuchtohowwell #jacr Thu Feb 26 9:51:11 PST 2015

drgmcginty The #radiology community is embracing change through #imaging3 #JACR Thu Feb 26 9:51:11 PST 2015

jacrjournal RT @pfanderson: @MightyCasey "Defensive medicine" is an oxymoron of sorts #jacr

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 20/23

Thu Feb 26 9:51:23 PST 2015

healthnfitnss RT @MightyCasey: @pfanderson Practicing w/1 eye on the patient, other overshoulder looking for lawyers. Can go blind that way. #jacr http:… Thu Feb 26 9:51:32 PST 2015

marthaabernathy RT @UM_VBID: @MattHawkinsMD Agree. We have long said that the mostexpensive therapy is the one that does not work. #howmuchtohowwell #j… Thu Feb 26 9:51:33 PST 2015

mightycasey RT @UM_VBID: @MattHawkinsMD Agree. We have long said that most expensivetherapy is the one that does not work. #howmuchtohowwell #jacr Thu Feb 26 9:51:37 PST 2015

jacrjournal RT @MightyCasey: @pfanderson Practicing w/1 eye on the patient, other overshoulder looking for lawyers. Can go blind that way. #jacr http:… Thu Feb 26 9:51:42 PST 2015

nxtstop1 RT @RogueRad: Embracing risk also adds value #JACR Thu Feb 26 9:52:09 PST 2015

matthawkinsmd @UM_VBID @economeer ­­ What about health "preserved" and for disease"excluded"? #JACR Thu Feb 26 9:52:18 PST 2015

radpac_man RT @NULall: @ruthcarlosmd We need more data to define value of imaging studies,like the great work being done by @NeimanHPI #jacr Thu Feb 26 9:52:22 PST 2015

jacrjournal RT @DrGMcGinty: The #radiology community is embracing change through#imaging3 #JACR Thu Feb 26 9:52:23 PST 2015

bjh41647 @RogueRad #jacr risk, no...uncertainty, yes. The key to efficient practice is knowingwhen no added info for doing more Thu Feb 26 9:52:28 PST 2015

jacrjournal RT @UM_VBID: @MattHawkinsMD Agree. We have long said that the mostexpensive therapy is the one that does not work. #howmuchtohowwell #j… Thu Feb 26 9:52:34 PST 2015

drgmcginty @UM_VBID isn't that a tall order for an individual clinician? #attribution is a challenge@economeer #jacr Thu Feb 26 9:52:44 PST 2015

kristinahoque RT @DrGMcGinty: The #radiology community is embracing change through#imaging3 #JACR Thu Feb 26 9:53:19 PST 2015

um_vbid @bjh41647 @rcarlos “In the middle of difficulty lies opportunity” ― Albert Einstein.Certainly applies to radiology HSR #JACR

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 21/23

Thu Feb 26 9:53:20 PST 2015

mightycasey RT @NULall: @ruthcarlosmd We need more data to define value of imaging studies,like the great work being done by @NeimanHPI #jacr Thu Feb 26 9:53:49 PST 2015

roguerad @bjh41647 Uncertainty can be risky #JACR Thu Feb 26 9:54:12 PST 2015

matthawkinsmd @UM_VBID @bjh41647 @rcarlos ­­ Well stated. Agree. #JACR Thu Feb 26 9:54:29 PST 2015

nxtstop1 RT @UM_VBID: @bjh41647 @rcarlos “In the middle of difficulty lies opportunity” ―Albert Einstein. Certainly applies to radiology HSR #JA… Thu Feb 26 9:54:34 PST 2015

pfanderson RT @MightyCasey: RT @NULall: @ruthcarlosmd We need more data to define valueof imaging studies, like the great work being done by @NeimanH… Thu Feb 26 9:54:46 PST 2015

mightycasey Guys, it's been a slice! Will depart leaving this: radiologists are CRITICALLYIMPORTANT, not much can get done without your input. #jacr Thu Feb 26 9:55:25 PST 2015

pfanderson RT @UM_VBID: @bjh41647 @rcarlos “In the middle of difficulty lies opportunity” ―Albert Einstein. Certainly applies to radiology HSR #JA… Thu Feb 26 9:55:50 PST 2015

bjh41647 @RogueRad #jacr ahhh, logic...if a=b, etc Thu Feb 26 9:55:50 PST 2015

drgmcginty RT @MightyCasey: Guys, it's been a slice! Will depart leaving this: radiologists areCRITICALLY IMPORTANT, not much can get done without yo… Thu Feb 26 9:55:59 PST 2015

pfanderson @UM_VBID @bjh41647 @rcarlos In libraries, where we need to focus training showswhere the poor design is positioned #jacr Thu Feb 26 9:56:21 PST 2015

um_vbid Many thanks for chatting with us today. Follow us @um_vbid andhttp://t.co/yfehhZXiL2. Please disseminate widely. #howmuchtohowwell #jacr Thu Feb 26 9:56:21 PST 2015

bsvercl RT @economeer: @DrGMcGinty @bjh41647 #JACR Hard to determine value ofimaging when there are no good metrics for value of medical care Thu Feb 26 9:56:28 PST 2015

nxtstop1 @MightyCasey Nice to have you with us Casey~ have a super day ~~~ #jacr Thu Feb 26 9:56:33 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 22/23

nulall @bjh41647 @RogueRad But we must go beyond knowing when added info = 0. Mustalso know when marginal value < extra cost. #jacr Thu Feb 26 9:56:59 PST 2015

rhwiggins @MightyCasey @MattHawkinsMD @bjh41647 As someone who used to be on theother side, yes, Imaging is vital to patient care...#JACR Thu Feb 26 9:57:19 PST 2015

bjh41647 @NULall @RogueRad #jacr exactly Thu Feb 26 9:57:51 PST 2015

um_vbid @bjh41647 @ruthcarlosmd “In the middle of difficulty lies opportunity” ― AlbertEinstein. Radiology must invest in HSR #JACR Thu Feb 26 9:58:21 PST 2015

matthawkinsmd @UM_VBID ­­ Thanks for your input and expertise. A critical, but open­minded crowd­­ I promise. #JACR Thu Feb 26 9:58:21 PST 2015

jacrjournal RT @MightyCasey: Guys, it's been a slice! Will depart leaving this: radiologists areCRITICALLY IMPORTANT, not much can get done without yo… Thu Feb 26 9:58:41 PST 2015

ruthcarlosmd Another great hour. Thanks to Mark Fendrick @UM_VBID for guest mod #JACR tweetchat on insurance design and imaging care. >1M impressions Thu Feb 26 9:58:52 PST 2015

nxtstop1 Pain Point.MT @NULall: @bjh41647 @RogueRad But we must go beyond knowingwhen added info = 0 &also know when marginal value<extra cost #jacr Thu Feb 26 9:58:52 PST 2015

ruthcarlosmd #JACR top 10 @pfanderson @nxtstop1 @radiologyacr @mightycasey @MDaware@DrGMcGinty @MattHawkins @UM_VBID @Jim_Rawson_MD @KristinaHoque Thu Feb 26 9:59:09 PST 2015

drivenbyhealth1 RT @nxtstop1: T3 With health insurance scrutinizing multiple similar exams,crucialthat the first exam be the best> may be only & always th… Thu Feb 26 9:59:12 PST 2015

rhwiggins @MightyCasey @MattHawkinsMD @bjh41647 ...But it is OUR job to get involved incare with both the patients &referring clinicians #JACR Thu Feb 26 9:59:41 PST 2015

kristinahoque #JACR thank you everyone for this very VALUABLE discussion ­ wonderful to hearfrom all prospectives! Thu Feb 26 10:00:03 PST 2015

kristinahoque #JACR @bjh41647 so glad your battery lasted hope you stay warm and dry!@nxtstop1 hope you stay safe and dry as well! Thu Feb 26 10:00:09 PST 2015

2/26/2015 #JACR ­ Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=02%2F26%2F2015&shour=09&smin=00&tdate=02%2F26%2F2015&thour=10&tmin=15 23/23

ruthcarlosmd Another great hour. Thanks to Mark Fendrick @UM_VBID for guest mod #JACR tweetchat on insurance design and imaging care. Thu Feb 26 10:00:26 PST 2015

kristinahoque RT @ruthcarlosmd: Another great hour. Thanks to Mark Fendrick @UM_VBID forguest mod #JACR tweet chat on insurance design and imaging care… Thu Feb 26 10:00:35 PST 2015

ruthcarlosmd See you next month 3/26 at 12ET. @KristinaHoque guest mod on Residency andwork life balance #radres #JACR Thu Feb 26 10:00:39 PST 2015

nxtstop1 RT @ruthcarlosmd: See you next month 3/26 at 12ET. @KristinaHoque guest mod onResidency and work life balance #radres #JACR Thu Feb 26 10:00:56 PST 2015

kristinahoque RT @ruthcarlosmd: See you next month 3/26 at 12ET. @KristinaHoque guest mod onResidency and work life balance #radres #JACR Thu Feb 26 10:01:31 PST 2015

nxtstop1 Thanks to all for an edifying chat today~ Ruth, our guests & the diverse participants.Best to each & Have a lovely day~~ #jacr Thu Feb 26 10:02:09 PST 2015

economeer RT @RogueRad: Value of radiologist ­ Value of Information ­ Reduce bandwidth ofpossibilities #JACR Thu Feb 26 10:05:23 PST 2015

geriasonomd More bedside ultrasound for diseases like renal colic and less reliance on CT. Needsto be multi specialty effort. #JACR Thu Feb 26 10:06:48 PST 2015

pfanderson @MightyCasey We need a better way. I tend to think participatory medicine is the path... #s4pm #jacr Thu Feb 26 10:08:46 PST 2015

sumersethi RT @KristinaHoque: @ruthcarlosmd #JACR this is the key of the Imaging 3.0campaign ­ each radiologist must be an indispensable member of th… Thu Feb 26 10:09:25 PST 2015

sumersethi RT @RogueRad: Value of radiologist ­ Value of Information ­ Reduce bandwidth ofpossibilities #JACR Thu Feb 26 10:09:54 PST 2015

mightycasey @rhwiggins @MattHawkinsMD @bjh41647 Just let patients help. It's that simple.Reach out to expert #epatient folks. Magic ensues. #jacr #s4pm Thu Feb 26 10:13:13 PST 2015

rhwiggins RT @MightyCasey: @rhwiggins @MattHawkinsMD @bjh41647 Just let patients help.It's that simple. Reach out to expert #epatient folks. Magic e… Thu Feb 26 10:13:32 PST 2015