Candid Impressions

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The Economics Committee of the Patient- and Family-Centered Care Commission conducts a survey about patients’ imaging expectations, with positive results.

Although much research has been done to gauge patient attitudes toward their imaging experience, it has mainly been confined to hospital-wide or regional surveys. Since the stated goal of the Economics Committee of ACR’s Patient- and Family-Centered Care Commission (PFCC) is to provide input in the development of ACR-backed value-based payment models and measures that deliver patient-defined value, committee leadership decided to assess what patients currently value in the process of obtaining a diagnostic image, as well as their expectations for the radiologist in that process.

After an exhaustive literature search, committee Chair Syed F. Zaidi, Vice President Clinical Operations of Radiology Partners and committee Vice-Chair Melissa M. Chen, Assistant Professor of Radiology at MD Anderson Cancer Center concluded that no national assessment measuring patient satisfaction with their imaging experience had been undertaken. Because of this, leadership decided to conduct a nationwide survey to see if any gaps in radiological care existed and, if so, how they could be addressed.

The results of this project would serve two specific aims: First, the committee would use the feedback as the basis for developing practice improvement activities that patients value — not activities that radiologists think patients value, an all-too-common trap that many physicians fall into. If we could prove that patient-centered practice is as good for a group’s financial bottom line as it is for office morale, perhaps it would spur quicker adoption of patient-responsive care across radiology.

Our second goal was to use the data to develop patient-defined and -reported outcome measures for CMS’ consideration. The first step in this process would be to communicate the survey results to ACR members who sit on CMS’ Technical Expert Panel (TEP). The TEP “is a group of stakeholders and experts who contribute direction and thoughtful input to the measure developer in every phase of the measure development process, from conceptualization through maintenance.”1 Engaging in measure development based on factors that patients demonstrably care about, we reasoned, would go a long way toward CMS adopting such value-based measures.

Where to start? After concluding our literature search, we moved on to deciding which aspects of imaging care patients could plausibly care most about. To get at this, we used as inspiration a list of potential value-based payment metrics assembled by ACR’s Economics Committee on Value-Based Payment Models.

Once we’d pared down this extensive list, we solicited feedback from the PFCC to see which potential metrics we should construct survey questions around. Commission members responded enthusiastically to our call for feedback, and before long we had composed a solid list.

With our measures in hand, we engaged Mary Jo Tarrant, Director of Portfolio Planning and Environmental Intelligence in ACR’s Office of Strategic Planning & Business Excellence, to help us put together questions that would gauge whether or not imaging patients cared about the metrics we thought were most relevant to radiology. Mary Jo has extensive experience in building surveys and with her guidance, we honed the metrics into survey questions.

After a round of review of the newly-developed survey questions by the committee, with Mary Jo’s assistance we engaged an outside market research vendor to execute the patient survey. The study would need to be quantitative in nature to produce accurate and reliable data projectable to the national population of patients. Respondents would include patients who were imaged in the past 12 months in all settings, taking into account a wide cross-section of modalities and body parts.

Interviews of 1,000 individuals were completed within a month’s time. Although the survey results seem to point to exciting opportunities for direct radiologist-patient interaction, the committee has decided to enact a follow-up survey to ensure our analysis is sound. In the next survey, we plan to ask respondents more directly their feelings about engaging with radiologists. Here are some of the committee’s tentative findings at this point:

• We found an incidence rate of four in ten people having been imaged in the past year.
• Scan or image interpretation by a radiologist and the actual procedure itself are the most important aspects of the imaging experience among respondents.
• The ease of understanding the imaging report and the timeliness of the report represent the second tier of important experiential characteristics.
• Because interpretation by a radiologist and the procedure itself are viewed as extremely important to patients, ACR has an opportunity to support and highlight the importance of radiologists having a more direct role in communicating imaging/scan results to patients.

Soon after the conclusion of the survey, committee leaders engaged with TEP representatives for guidance on next steps. In principal, these representatives have encouraged us to leverage the data toward the development of one or more patient-centric MIPS improvement activities. The goal of these activities will be to improve patient satisfaction by increasing communication and care coordination.

Moving forward, in addition to conducting a follow-up survey, the committee will commence gathering data from current efforts underfoot in the radiology community to consult directly with patients. Once we have collected more data, we will present a proposal to the TEP with respect to radiologist-patient consultations.


By Chris Hobson, Imaging 3.0 Senior Communication Manager

Endnote
1CMS.gov. “Technical Expert Panels.” Available at http://bit.ly/TEPRadiology. Accessed on November 20, 2017.


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