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

[ Insert organization name ]

Rev 2014

[ Insert organization name ]

Overview

 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

What Does It Mean To Be Focused On Our Patients?

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

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!

Patient-centered Radiology

The components: Billing Scheduling Registration Results Reporting PATIENT-CENTERED EXPERIENCE Reception

http://www.hoaghospital.org/radiology/

Caregiver Interactions

Perception Is Reality…

Waiting Room “LOUNGE”

Putting Patients First

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

Why Should Radiologists Be Patient-centered?

“Professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician...” Excerpt from Medical Professionalism in the new millennium: A Physician Charter ABIM Foundation ACP-ASIM Foundation European Federation of Internal Medicine

Doctor-Patient Relationship

 Traditional, built on familiarity and trust  The foundation of the place and influence of physicians in society

Yet it’s:

 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; 241:11-16

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.

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).

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.

“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)

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.

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/gynecologists, neurologists, orthopedic surgeons, cardiologists and urologists. Office-based imaging services offer three important advantages to patients. First, speeds correct diagnosis and treatment of the patient’s 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_021005.htm

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

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.

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

Patient-centered Primary Care Collaborative

Examples of Broad Stakeholder Support and Participation

AAMC Annual Meeting Nov 2008

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

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

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

Some CAHPS Survey Topics Relevant To Imaging

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

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

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

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

Why We Should Be Patient-centered

       We are physicians, professionals Maintenance of certification (MOC) requirement We’ve been “invisible” Competition from other specialties Rendered anonymous by our own technology Mainstream medicine’s Patient-Centered Medical Home What patients (and payors) want

How Can Radiologists Be Patient-centered?

Be Visible

 Meet and greet  Discuss results  Make the radiologist-as-physician connection with your patients  Give radiologists a face and a value as 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

Patients expect

would not be good.

timely results

“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 .

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

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.

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

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; 300:305-306

Trepidation Of Disclosure Unfounded

Radiologists need not be afraid of disclosure!

 In 2003,

1,275,300

cancer, and

23,345

newly diagnosed cases of radiologists  Even if every case is diagnosed by a radiologist, that’s one abnormal result per week per radiologist American Cancer Society

(http:www.cancer.org)

Pasko T, Smart D. Physician Characteristics and Distribution in the U.S.

JAMA

2005; 1

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 group’s 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 Hospital’s 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 <<

(949)xxx-xxxx

>> 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 <<<<

fill in

>>>>>. To schedule your next appointment, call <<<<

fill in

>>>>> . We look forward to providing imaging services for you again.

Sincerely, The Physicians of Newport Harbor Radiology Associates

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; 165:467-469

What Radiologists Need To Do

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

Implementing Patient-centered Radiology:

A Case Study & Lessons Learned Hoag Memorial Hospital Presbyterian

Newport Beach, California

A Case Study

Background On Hoag Hospital

 498-bed acute care not-for-profit hospital  JCAHO 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

A Case Study

Accuracy Of Appointment

 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

A Case Study

Patient Access

 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

A Case Study

Reception

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

A Case Study

Measure The Steps… Focus On Sources Of Variability

 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

A Case Study

Report Turnaround Times

 Hoag Hospital report turnaround time = 99% less than 8 hours  Best in Class benchmark less than 4 hours o < 8 hours 10% o < 4 hours 15% o < 1 hour 12% o < 5 minutes 63% Data source: Hoag Hospital CPOG report Jan-Dec 2005

A Case Study Lessons learned

Patient Delays And Wait Times

You can’t manage what you can’t 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

A Case Study Lessons learned

Understand Your Customer’s Expectations

Inform the patient when they should expect their exam results

A Case Study Lessons learned

Billing Accuracy: Related To Patient Satisfaction 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

A Case Study Lessons learned

Billing Accuracy: Related To Patient Satisfaction

 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

Change Isn’t Easy… Especially Cultural Change

 Culture eats s trategy for lunch…  But good management can change culture  And,

it’s time for a change!

Why?

   

Radiology As Commodity: Drivers

Consumer Driven Care PACS/Teleradiology

o o CAD Demystification of the technology o o In-office clinician imaging Corporatization of Radiology

Internal Factors

o Volume per FTE: The Time/Money Dynamic o Lack of Sub-specialization o o 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)

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

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

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

Patients Ask: What’s 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

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

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.

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.

MODEL OF CARE

 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 Radiology Cares® pledge in support of patient-centered practices

Resources At Your Fingertips



RadiologyCares.org



RadiologyInfo.org



ImageGently.org



ImageWisely.org



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 in both 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 o Results o 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

Spread The Word About Patient-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

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

Patient-centered Future Initiatives

 One-stop registration and scheduling to include Web-enabled appointment access for patients and referring physicians  Patient-accessible Web page o Results o 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

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 patient –centered radiology programs. How do you practice it?

 Send stories and examples to RSNA at

[email protected]

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.