Healthcare transformation is at the top of the agenda for all industry stakeholders. But the magnitude of this change varies from stakeholder to stakeholder. For many radiologists, radiology practices and radiology departments, transformation means a complete overhaul of how they’ve done things in the past, with that overhaul being driven by the power of transparency.
Consider three of the forces behind the push for healthcare transformation:
1. The transition from fee-for-service medicine to value-based reimbursement.
This transition was occurring naturally until 2015, when Congress pushed the pedal by passing the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA formed the Quality Payment Program that’s causing a seismic shift in the way Medicare—and, subsequently, private payers—will reimburse physicians.
2. Clinical decision support.
Medicine, regardless of specialty, is no longer a profession that’s practiced by doctors in a silo and based solely on experience, knowledge and instinct. It’s a profession that requires clinical collaboration and care coordination with other clinicians. And it’s a profession in which clinical decision support tools and technologies can greatly aid performance.
3. Healthcare consumerism.
Patients have a choice of when and where to receive their non-emergent medical services. They have access to consumer ratings and grades of competing providers. They have access to tools that allow them to compare the quality, safety and prices of competing providers. And they have a financial incentive to do so because of their higher out-of-pocket cost responsibilities.
Now consider the traditional business model that many radiologists, radiology practices and radiology departments follow. Virtually every aspect of that traditional business model is at odds with the three forces above.
Revenue is determined by volume, not value. It’s how many imaging studies they do, not whether those studies were clinically necessary, read correctly or resulted in an optimum clinical outcome. Radiologists and radiology practices work in relative isolation from referring physicians and other clinicians, reading scans and sending them on their way. They spend little, if any, time with patients directly. And their work volume largely depends on orders from institutional providers like hospitals and referring physicians, not from consumers directly.
The challenge becomes how to remake that traditional business model in ways that work with or take advantage of those three forces instead of fighting against them. Radiologists and radiology practices and departments need to rethink how they do business.
I believe that process should start with embracing transparency as the agent of change to transform clinically and financially at all levels of the operation. Let’s look at how transparency converts each of those three forces into allies.
The value in value-based reimbursement comes from producing the best possible clinical outcomes at the lowest possible costs. In radiology, that means performing the right imaging tests, performing them on the right patients, avoiding unnecessary or duplicative imaging procedures, interpreting test results accurately and quickly, and ensuring that test results advance the care of patients. All facets of radiology services can be measured by quality, safety and cost performance criteria with the data collected, stored and analyzed. Data can be
reported back to practitioners in a transparent fashion to make performance improvements, and to payers in a transparent fashion to justify reimbursement.
Transparency is the sledgehammer needed to knock down the silos that prevent collaboration and coordination. I compare it with an open-concept floor plan in a house. Radiologists need to knock down the walls in order to communicate with other departments and understand how their work affects the work of everyone else along the continuum of patient care. That includes understanding how their work affects reimbursement. Transparency means openly using evidence-based clinical support tools and technologies to improve decision-making. For management, it means openly conveying the reasons why changing the business model is good for patient care. A common mistake leadership makes is telling radiologists to change without telling them why they should.
Transparency aids choice
Transparency is the appropriate response to consumerism. In non-emergent situations, many patients have a choice of where to receive imaging tests. Radiology doesn’t control that narrative anymore. To remain competitive, radiologists and radiology practices and departments should consider quality and price transparency as market advantages. Making performance and price information publicly available, and certainly available to referring physicians, is crucial. Practices should consider advertising to raise their visibility. Some should consider paid search, as many patients shop online for imaging procedures.
Transparency in performance. Transparency to the patient-care team. Transparency to consumers. Radiologists, radiology practices and radiology departments that pursue these tactics can replace their tired business model with a vibrant model that positions them for clinical and financial success in the future.
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