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

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

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

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Patient-centered Radiology

• The components

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

Waiting Room LOUNGE
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Putting Patients First

• Minimize delays
• Increase communication
• Create a welcoming environment of caring,
  responsive people

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Why Should Radiologists Be Patient-centered?
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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
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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
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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.

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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).

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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.

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• 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)
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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.

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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
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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
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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.

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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

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Patient-centered Primary Care Collaborative

• Examples of Broad Stakeholder Support and
  Participation

AAMC Annual Meeting, Nov 2008
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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
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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

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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

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Some CAHPS Survey Topics Relevant To Imaging

• Communication with doctors
• Communication with nurses
• Responsiveness of staff
• Discharge information

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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
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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

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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

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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

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How Can Radiologists Be Patient-centered?
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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

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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.
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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.
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Lessons Patients Learn From Talking With
Radiologists

• Radiologist as Imaging Expert, Knowledgeable
  Physician
• Radiologist as Patient Advocate
• Radiologist as Gatekeeper
• Radiologist as ReferringPhysician

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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.

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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
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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
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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
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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

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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
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What Radiologists Need To Do

• Differentiate your practice
• Provide great local services
• Provide personal service

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Implementing Patient-centered RadiologyA Case
Study Lessons Learned

• Hoag Memorial Hospital Presbyterian
• Newport Beach, California

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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

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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

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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

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Reception
A Case Study

• Greeter during peak volumes
• Manage patient arrivals
• Improve waiting room environment
• Invite patients to inquire about delays

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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

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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
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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

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Understand Your Customers Expectations
A Case Study
Lessons learned
Inform the patient when they should expect their
exam results
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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

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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

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Change Isnt EasyEspecially Cultural Change

• Culture eats strategy for lunch
• But good management can change culture
• And, its time for a change!

Why?
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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)

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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

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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

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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

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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

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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

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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.
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• 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.

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

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Resources At Your Fingertips

• RadiologyCares.org
• RadiologyInfo.org
• ImageGently.org
• ImageWisely.org

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• 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

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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

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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

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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

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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

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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

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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.