Getting Specific About Patient-Centered Care
The chair of ACR’s newest commission looks at where radiology fits into value-based health care.
For my column this month, I spoke with James V. Rawson, MD, FACR, about his latest role at the ACR, as chair of the brand new Commission on Patient Experience. I’ve worked with Jim for several years in his role as chair of our Committee on the Hospital Outpatient Prospective Payment System (HOPPS) and treasure him as a colleague and friend.
He’s also a leader in our digital community with more than 3,000 followers on Twitter (find him at @Jim_Rawson_MD). Jim explained the commission’s first steps, addressed the ways in which patient experience is increasingly tied to reimbursement, and told us how he responds when people say radiologists should stay in the reading room.
What are the goals of the new commission?
We’re building out a commission that will move quickly and work in a collegial way with all the other aspects of the College. Our goal is be an enabler of patient- and family-centered thinking throughout radiology and health care. We need to engage our entire profession — including diagnostic radiologists, radiation oncologists, medical physicists, interventional radiologists, nuclear medicine physicians, and generalists. We also need to reach out beyond radiology to fully participate in and act as leaders in team-based care.
In addition to partnering with other professional medical societies, we’re reaching out to patient-centered care experts like the Institute for Patient- and Family-Centered Care and the Beryl Institute. We’re also looking for ways radiology can take a leadership role in forming interdisciplinary practice teams across care settings.
In a busy world of competing priorities, the patient experience can sometimes get a little lost in discussions about health care. What made this a focus in your career?
It’s something that I was always interested in, in part because my wife and I had sick relatives throughout my medical training. I was never able to lose the patient and family perspective because I was always in that role.
When I started practicing, I took that experience with me. I was fortunate to work in an institution in which people wanted to look at the world through that lens. That patient and family-centered perspective was encouraged at the Medical College of Georgia at Georgia Regents University.
How do we shift our mindsets and our systems to become more patient focused?
One of the challenges is convincing people that this should rise to the top of the list of things they’re trying to do right now. Patient engagement is a critical element in the redesign of the country’s health care system, and we will not be successful without a fully developed partnership while we’re working on change.
Ask yourself and your colleagues if you want your own care and that of your family to be done to you or with you. Is the often-disconnected and inefficient type of care occurring in health care today what you would want for your family member or yourself? Another approach is to remind our colleagues that hospitals are increasingly making use of patient satisfaction measures. Even if you make the right diagnosis, poor ratings around patient experience can put your income at risk.
How is the commission supporting radiologists in communicating directly with patients?
We recognize that radiologists do not always have the opportunity to interact directly with patients and have conversations about care. However, this type of communication will be increasingly important to ensuring patients are empowered to make decisions about their health care (a key component of a positive patient experience). Patients, families, and physicians should be partners in care. To support radiologists in developing these skills right now, we are working with other commissions to plan patient-centered programming for the ACR 2016 meeting.
As you know, there’s a College-wide initiative to provide input on new payment metrics to Medicare. What types of metrics should radiologists be prepared to put ourselves at risk for and drive toward?
There are two ways to look at these metrics. We can use easy measures with little exposure to risk and probably little impact. These metrics would be specific to radiologists and completely under the control of radiologists. Such a metric is comfortable to radiologists because we are only responsible for ourselves and do not have personal income at risk for other people’s behaviors.
For example, we could measure radiology report turnaround time. The limitation of this approach is the reality that medicine is a team sport, and the impact of one provider in isolation is small in the context of the overall outcomes of the patient.
The second approach looks at important drivers of health in which we have less control and more risk. The challenge is how much risk we want to take but also how much impact we want to have on the patient. Such a metric brings more risk since neither the individual radiologist nor the radiology profession has complete control.
If you were to choose one metric that would have significant impact on the health of the population, you could choose body mass index (BMI), which is used to determine obesity. Most radiologists would be uncomfortable with having income at risk for population BMI. There is no CPT code for this. There is no immediate impact of a chest x-ray interpretation on BMI. However, one approach to the more impactful, but riskier, metric would be to share the risk (and the responsibility).
Medicare has a history of using composite measures. Some estimates attribute 10 percent of U.S. health care costs to obesity, diabetes, and related conditions. Even a modest reduction in BMI would have savings. Furthermore, if we created a coalition of several professional societies, the alignment could be very powerful.
Some in health care think radiologists should just focus on working quickly and getting the reports out. There’s a feeling that patient experience isn’t a space in which we’ll ever be able to win. What do you think?
Radiologists need to be efficient, but that is not enough. Let’s be clear, if we don’t take care of our patients, someone else will. And then we will have a lot of time on our hands. This is about the patient, not us.
One of my favorite Imaging 3.0™ aphorisms is Jim Rawson’s. Jim says, “It’s hard to put the patient in the center if you are sitting there yourself.” Jim has been a visionary leader in his own institution in shifting the focus to the patient, and I’m really looking forward to his extending those efforts across our profession.
From the Chair of the Commission on Economics
By Geraldine B. McGinty, MD, MBA, FACR, Chair