Sponsored by thePatient-Centered Radiology Steering Committee

of the Radiological Society of North America

Patient-centered Radiology

Introducing

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?

Excerpt fromMedical Professionalism in the new millennium: A Physician Charter

ABIM FoundationACP-ASIM Foundation

European Federation of Internal Medicine

“Professionalism is the basis of medicine’s contract with society. It demands placing

the interests of patients above those of the physician...”

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

Fulfills 3 of 6 competencies required for MOC:

Interpersonal and communication skills

Patient care

Professionalism

Maintenance Of Certification (MOC)

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, BerkeleyThe end of managed care. JAMA 2001 May

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

Change Trajectory

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

Radiologist As A Patient-centered Physician

What Does It MeanFor A Radiologist To Be Focused

on Patients?

Lessons From Colon Screening:

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!

Patients Want…

Patient-centered RadiologyComponents:

PATIENT-CENTEREDEXPERIENCE

SchedulingRegistration

Reception

CaregiverInteractions

ResultsReporting

Billing

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 radiologist-as-physicianconnection 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.

“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.

Patients expect timely results

Radiologists Can Help Ease Your Patients’ Concerns

Direct communication with patient about:o The diagnostic processo Purpose for the examo Radiation concernso Important finding

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

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

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 instructionso 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 CADo Demystification of the technologyo In-office clinician imagingo Corporatization of Radiology

Internal Factorso Volume per FTE: The Time/Money Dynamic o Lack of Sub-specializationo Nighthawko 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’sMedical Imaging Expertise!

Communicate with your radiologistso Find out about their special skills and practices

Invite them to participate in multidisciplinary conferences and rounds

Call them for questions about:o appropriateness of examso radiation safetyo newly available imaging modalities and interventional

procedures

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

What Is Radiology Cares®?

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.orgInformation about reducing radiation dose during imaging of children

ImageWisely.orgInformation 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.