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Title: Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America


1
Sponsored by thePatient-Centered Radiology
Steering Committeeof the Radiological Society of
North America
Insert organization name
Rev 2015
2
Overview
Insert organization name
  • 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

3
What Does It Mean To Be Focused On Our Patients?
4
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
5
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!

6
Patient-centered Radiology
  • The components

Billing
Scheduling Registration
PATIENT-CENTERED EXPERIENCE
Results Reporting
Reception
Caregiver Interactions
http//www.hoaghospital.org/radiology/
7
  • Perception Is Reality

Waiting Room LOUNGE
8
Putting Patients First
  • Minimize delays
  • Increase communication
  • Create a welcoming environment of caring,
    responsive people

9
Why Should Radiologists Be Patient-centered?
10
Excerpt fromMedical Professionalism in the new
millennium A Physician Charter
Professionalism is the basis of medicines
contract with society. It demands placing the
interests of patients above those of the
physician...
ABIM FoundationACP-ASIM FoundationEuropean
Federation of Internal Medicine
11
Doctor-Patient Relationship
  • Traditional, built on familiarity and trust
  • The foundation of the place and influence of
    physicians in society
  • Yet its
  • 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 24111-16
12
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.

13
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).

14
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.

15
  • 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)
16
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.

17
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/gyneco
logists, neurologists, orthopedic surgeons,
cardiologists and urologists. Office-based
imaging services offer three important advantages
to patients. First, speeds correct diagnosis and
treatment of the patients 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_0
21005.htm
18
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
19
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.

20
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

21
Patient-centered Primary Care Collaborative
  • Examples of Broad Stakeholder Support and
    Participation

AAMC Annual Meeting, Nov 2008
22
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
23
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

24
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

25
Some CAHPS Survey Topics Relevant To Imaging
  • Communication with doctors
  • Communication with nurses
  • Responsiveness of staff
  • Discharge information

26
Important Strategy Insight
  • Postulate An organizations strategy cannot
    succeed unless it is aligned with the industrys
    change trajectory.
  • Def The change trajectory is determined by two
    threats of obsolescence
  • Threats to industrys core activities
  • Threats to industrys core assets

McGahan AM. How Industries Change. Harvard
Business Review. October 2004
27
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

28
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

29
Why We Should Be Patient-centered
  • We are physicians, professionals
  • Maintenance of Certification (MOC) requirement
  • Weve been invisible
  • Competition from other specialties
  • Rendered anonymous by our own technology
  • Mainstream medicines Patient-Centered Medical
    Home
  • What patients (and payors) want

30
How Can Radiologists Be Patient-centered?
31
Be Visible
  • Meet and greet
  • Discuss results
  • Make the radiologist-as-physicianconnection
    with your patients
  • Give radiologists a face and a value as part of
    the healthcare team

32
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.
33
Sick and Scared, and Waiting, Waiting, Waiting
By Gina KolataPublished 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.
Patients expect timely results
Kolata G. (2005). Sick and Scared, and Waiting,
Waiting, Waiting. The New York Times.
34
Lessons Patients Learn From Talking With
Radiologists
  • Radiologist as Imaging Expert, Knowledgeable
    Physician
  • Radiologist as Patient Advocate
  • Radiologist as Gatekeeper
  • Radiologist as ReferringPhysician

35
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.

36
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
165467-469
37
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
300305-306
38
Trepidation Of Disclosure UnfoundedRadiologists
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,
    thats one abnormal result per week per
    radiologist

American Cancer Society (httpwww.cancer.org) Pask
o T, Smart D. Physician Characteristics and
Distribution in the U.S. JAMA 2005 1
39
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 groups 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
    Hospitals 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 ltlt(949)xxx-xxxxgtgt
    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 ltltltltfill ingtgtgtgtgt. To schedule your
    next appointment, call ltltltlt fill ingtgtgtgtgt . We
    look forward to providing imaging services for
    you again.
  •  
  • Sincerely,
  • The Physicians of Newport Harbor Radiology
    Associates

40
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
165467-469
41
What Radiologists Need To Do
  • Differentiate your practice
  • Provide great local services
  • Provide personal service

42
Implementing Patient-centered RadiologyA Case
Study Lessons Learned
  • Hoag Memorial Hospital Presbyterian
  • Newport Beach, California

43
Background On Hoag Hospital
A Case Study
  • 498-bed acute care not-for-profit hospital
  • Joint Commission 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

44
Accuracy Of Appointment
A Case Study
  • 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

45
Patient Access
A Case Study
  • 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

46
Reception
A Case Study
  • Greeter during peak volumes
  • Manage patient arrivals
  • Improve waiting room environment
  • Invite patients to inquire about delays

47
Measure The StepsFocus On Sources Of Variability
A Case Study
  • 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

48
Report Turnaround Times
A Case Study
  • Hoag Hospital report turnaround time 99 less
    than 8 hours
  • Best in Class benchmark less than 4 hours
  • lt 8 hours 10
  • lt 4 hours 15
  • lt 1 hour 12
  • lt 5 minutes 63

Data source Hoag Hospital CPOG report Jan-Dec
2005
49
Patient Delays And Wait Times
A Case Study
Lessons learned
  • You cant manage what you cant 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

50
Understand Your Customers Expectations
A Case Study
Lessons learned
Inform the patient when they should expect their
exam results
51
Billing AccuracyRelated To Patient Satisfaction
A Case Study
Lessons learned
  • 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

52
Billing AccuracyRelated To Patient Satisfaction
A Case Study
Lessons learned
  • 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

53
Change Isnt EasyEspecially Cultural Change
  • Culture eats strategy for lunch
  • But good management can change culture
  • And, its time for a change!

Why?
54
Radiology As Commodity Drivers
  • Consumer Driven Care
  • PACS/Teleradiology
  • CAD
  • Demystification of the technology
  • In-office clinician imaging
  • Corporatization of Radiology
  • Internal Factors
  • Volume per FTE The Time/Money Dynamic
  • Lack of Sub-specialization
  • Nighthawk
  • 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)

55
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

56
Added Value/Competitive Advantage Of On Site
Radiologists
  • Supervision of equipment, choices, discounts
  • Quality control / peer review / Joint Commission
    standards credentialing
  • Participation in medical staff governance
  • Participation in hospital operations
  • Involvement in strategic planning
  • Attendance at organizational meetings
  • Promotion of services

57
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

58
Patients Ask Whats 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

59
(No Transcript)
60
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

61
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.
62
  • 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.

63
MODEL OF CARE
64
  • www.RadiologyCares.org
  • Radiologist resource for patient-centered care
  • Access to related scientific and consumer media
    articles and videos
  • Available customizable presentation decks

65
Resources At Your Fingertips
  • RadiologyCares.org
  • RadiologyInfo.org
  • ImageGently.org
  • ImageWisely.org

66
  • An Available Quality Patient Communication
    Resource
  • www.RadiologyInfo.org
  • Descriptions of over 200 procedures, exams and
    disease topics covering diagnostic and
    interventional radiology, nuclear medicine,
    radiation therapy and radiation safety
  • Reassures patients and saves physician time
  • Free, credible radiology information in
    easy-to-understand language
  • Tells your patients what to expect
  • Reviewed by radiologists (RSNA and ACR)
  • Available in both English and Spanish

67
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

68
Spread The Word AboutPatient-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

69
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

70
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

71
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 patientcentered
    radiology programs. How do you practice it?
  • Send stories and examples to RSNA at
    radiologycares_at_rsna.org

72
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.
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