Daily Bulletin 2017

The Value-Based Model is Here — the Time for Action is Now

Wednesday, Nov. 29, 2017

While radiologists have been talking the value talk for several years now, it's time they started "walking the value walk," said Jonathan B. Kruskal, MD, PhD, during Tuesday's Annual Oration in Diagnostic Radiology.

While there has been much discussion within radiology about the specialty's transition from the volume to value era, the message simply is not getting across, Dr. Kruskal said in his lecture, "Strategies for Radiology to Thrive in the Value Era."

Jonathan B. Kruskal, MD, PhD, delivers the Annual Oration in Diagnostic Radiology

But change is coming. For example, Dr. Kruskal noted that his hospital has been notified that next year the Massachusetts Medicaid program will "substantially" shift from fee-for-service to a value-based model.

"So this is happening," said Dr. Kruskal, chairman of the Department of Radiology, Beth Israel Deaconess Medical Center in Boston, and professor of radiology, Harvard Medical Center. "This is the real world. We are starting to be paid on our value contribution and we have to get down to the nitty-gritty and understand what it is we can do as radiologists to add value to our customers."

"Ultimately, the major reason radiologists have not embraced the value concept is that we still don't know what value is, how to measure it, or how best to provide it to our customers," he said.

In a tweet sent to Dr. Kruskal during his talk, James Rawson, MD, of the Medical College of Georgia, interjected that radiologists need to understand that they don't define value, "their customers do." Which means that radiologists need to know who their customers are (referring physicians and patients), how to talk to — not at — them, and then listen to them and act on their feedback.

"And value," Dr. Kruskal maintained, "is really reflected in costs to the patient and the system, the quality and perceived quality of services, the experience of the patient and other customers, and outcomes."

The Reading Room Door Should Always Be Open

Dr. Kruskal described strategies that radiologists can follow to add value, such as providing appropriate and efficient care; delivering excellent service and data-driven and data-supported care; being visible, valuable, accessible and affable team members; learning and improving continuously; providing unambiguous reports and communication; and engaging their customers and stakeholders.

And being visible, accessible and affable to patients doesn't happen by sitting in front of a PACS monitor, Dr. Kruskal said. He added that the door to the reading room should always be open so that radiologists are available and ready to help improve outcomes.

Dr. Kruskal noted that the quality of a radiologist's product — the report — also needs improving, so that what the radiologist sends out is representative of the kind of professional service they aim to provide. Reports should be actionable, clearly reported and with no variation.

"Why not commit to this as a practice quality improvement (PQI) opportunity?" he asked. "I would love every practice in this country to say that in 2018 they were each going to undertake a PQI project to improve their reports."

Dr. Kruskal also said that radiologists add value by practicing appropriate and efficient radiology, as well as continuously learning — and improving.

"We have to take peer review and peer learning more seriously," he said. "If we truly desire to add value and improve care by improving our performance, we have to shift from collecting retrospective and underreporting discrepancy data and embrace prospective peer learning — now."

Dr. Kruskal concluded by referring to the late Dr. Richard Baron's RSNA 2016 presidential address in which he said, "We as radiologists must extend our gaze beyond the constraints of the image to gain a broader perspective on the patient experience."

"It's absolutely all about the patient experience indirectly back to your primary customer, the referring physician," Dr. Kruskal said. "We have to take this seriously."

Tip of the day:

In CT contrast studies, lowering kVp can reduce both radiation and contrast dose.

The RSNA 2017 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.