Patient Experience and Payment Policy: One and the Same
The Commission on Economics is committed to ensuring opportunities for radiologists contribute to an improved patient experience.
Continually improving patient experience is what we strive for; it is the right thing to do. But if that were not motivation enough, policymakers have made patient experience an integral component of radiology payment policy.
Ignore patient experience, and we risk decreased payments — or not payments at all. The ACR Commission on Economics believes that we can achieve both: increased payments and improved patient safety and quality. But to do so, we must understand what brought this focus on patient experience to the forefront. By acknowledging and understanding the need for change, our chance of success is improved. In this column, I will also discuss some of the metrics that play to patient experience in new payment models, and highlight a number of tools available to us that will improve patient experience and earn us higher payments.
What is patient experience? I define it as being the care focused on safety, quality, convenience, and consideration. What prompted policymakers to realize that we could, and should, do better in this regard? These examples are many, and one comes from Donald M. Berwick, MD, the founder of the Institute for Healthcare Improvement and the CMS administrator during the early implementation of the Affordable Care Act. In Berwick's 1999 "Escape Fire" talk, he described his family's experience during an illness suffered by his wife, Ann. She had an autoimmune spine condition that led to six hospitalizations over 60 inpatient days at three different institutions. In his lecture, he states that "not a day went by without an error," and he describes a number of stressful circumstances. He uses radiology as an example, stating that "on at least three occasions I know of, she waited alone for over an hour, cold and frightened in a waiting area outside an MRI unit in the sub-basement in the middle of the night."
Shortly thereafter, the Institute of Medicine published To Err Is Human, showing at least 44,000 people — perhaps as many as 98,000 — die in hospitals each year as a result of medical errors that could have been prevented. Not long after that, Crossing the Quality Chasm was published. The first recommendation in that publication relates to setting patient-centric goals for improving the U.S. health care system. This is in contrast to developing hospital- or physician-centric goals that emphasize the needs of health care organizations and providers. At the time of its publication, this was a particularly ground-breaking concept: putting patients ahead of doctors and systems in importance.
I present these examples not to be overly negative or critical. But I want to highlight how policymakers have viewed the health care system and the fact that they do not think we can improve without economic incentives (or penalties). That brings us to today. We are being judged on the quality of patient experience at multiple levels. The Medicare Access & CHIP Reauthorization Act creates the Quality Payment Program (QPP). Under this program, payments are determined by either the Merit-Based Incentive Payment System (MIPS) or through Alternative Payment Models (APMs). Under MIPS, all four of the performance categories include metrics related to patient experience. Under the Quality category, there are a number of measures that relate to radiation dose, follow-up of incidental findings, and occurrence of IR complications. The Advancing Care category includes metrics related to patient access to radiology reports and health information exchange. Radiologists practicing within an Advanced APM are also subject to patient experience-related metrics, and the Consumer Assessment of Health Care Providers and Systems survey is required.
We neither can go back in time and improve the experience of Dr. Berwick's wife in the late '90s or reverse the Institute of Medicine's findings. But we can acknowledge that change is necessary, and we can be the instruments of that change. And there is no shortage of financial motivators to help us take those steps. Those interested in diving deeper into patient experience-related resources can find information at the Imaging 3.0® website, the Beryl Institute, and the RSNA Radiology Cares website. The Commission on Economics is committed to ensuring that opportunities for radiologists can contribute to improved patient experience continue to grow as the QPP evolves.
By Ezequiel Silva III, MD, FACR, Chair