Taking the Lead

Samir B. Patel, MD, created a document to safeguard his practice’s contract. What he didn’t realize is he’d started a national conversation on value.new image

It's a challenge all of health care is facing right now — how do you define value? At its most basic level, valuable means being worth something to someone.

But how do you make that tangible? And, more importantly, how do you determine just how valuable you are, especially when a lot of the activities you do aren’t assigned a monetary value? This is the problem Samir B. Patel, MD, radiologist at Radiology, Inc., in north central Indiana, and his colleagues encountered. Hospital administration was considering an end to the 100-year relationship with Radiology, Inc., for professional radiology services. Administration had heard from medical staff members that the only thing the radiology group did was interpret images, and because of this, they believed the practice could be easily replaced. So the practice needed a simple, efficient way to showcase its value.

Creating a Solution

Fortunately, Patel had already been working on this issue. He’d noticed a large amount of work the radiologists did was going undocumented and unrecognized. And as hospitals sought more value, Radiology, Inc., had to find a way to show it was working toward the same goal. Patel created the Radiology Value-Added Matrix, a template for categorizing and defining radiology value, which served as a guide to keep track of all the hours radiologists spent on value-added, non-billable activities.

“Nothing on the matrix has to do with interpretation of film. The matrix has everything to do with the activities that lead up to imaging, that occur during imaging, and that come after imaging,” said Patel in an Imaging 3.0™ webinar. At the end of the year, Patel translated the matrix into an executive summary that was presented to the hospital administration.

Performing Above and Beyond

Using the matrix, Patel showed, in addition to reading images, his group was also making huge strides in customer service, professional development, quality improvement, and resource management by doing such things as prioritizing patient interaction, participating in sedation monitoring, measuring outcomes, and more.

“We proved what the hospital is getting is not easily replaceable.… Not only do you need someone to interpret the films, but all these other investments would need to be matched if the same level of care is to be provided,” said Patel in the Imaging 3.0 case study based on the matrix. Last year alone, Patel’s value matrix showed his group had performed over 11,700 hours of non-work RVU-related tasks, including peer reviewing over 10,000 cases, participating in over 540 conferences, and serving on over 46 different hospital committees.

And hospital administration listened. “Once we presented to the administration and they realized all the work we do, there was a greater degree of respect and collaboration between us and the hospital. In turn, the administration recognition helps motivate our members to perform more work beyond the reading room,” says Patel in a recent interview.

Putting It Into Practice

You might think creating such a valuable tool is a difficult process. But Patel notes creating the matrix was incredibly easy. He recommends starting small: begin by choosing a few non-RVU activities (such as conference and committee participation) and recording the time they take in only one department or sub-department and then adding additional activities. His point is not to ask radiologists to do more, but rather document what value-added activities they are already performing.

At the end of each month, all of the activities from all sites of service are entered into an electronic spreadsheet. Radiology, Inc., designated a person from their billing office to do this task. Finally, the Value Management Program Director (in this case, Patel) reviews the entries submitted. At the end of the year the total number of hours in each category is tabulated and key metrics in each category are determined.

Creating a Conversation

So defining value may not be so hard after all. Patel and his team were able to define what value meant to their hospital and non-hospital clients by saving money and providing quality outcomes. And it turns out that others in the health care arena were listening.

Although Radiology, Inc., had set out simply to quantify the value of the work it was already doing and retain their contract, the group was chosen to be a best practice site interviewed by the Transforming Clinical Practice Initiative (TCPI), a program set up by the Affordable Care Act to strengthen the quality of patient care and help spend health care dollars more wisely.

The information from the site visit will guide CMS leaders in developing processes and programs for more than 140,000 physicians nationwide. “The fact that radiologists are participating at the highest levels in the national conversation about the transformation of the health care delivery system is incredibly important. We have always known high-quality imaging contributes significant value, but being at the table to tell our story means that policy will be shaped in a way that recognizes the value radiologists deliver,” says Geraldine B. McGinty, MD, MBA, FACR, vice chair of the ACR Board of Chancellors.

Want to join in on the national conversation on value? It can be as simple as taking note of all the important activities you do on a regular basis and making them into quantifiable data through reports and excel sheets (check out the tables in Patel’s article at bit.ly/MatrixJACR for an example). Or it can mean dedicating yourself to improving patient outcomes. The R-SCAN project is a part of TCPI that aims to connect radiologists and practicing physicians. (Learn more about how R-SCAN can help your practice improve imaging ordering at rscan.org.) Radiologists can partner with referring physicians in an effort to reduce imaging utilization based on Choosing Wisely topics. Patel notes, “Showcasing your story and value creates a relationship of respect and recognition with all health care stakeholders. That recognition elevates all of radiology, so indirectly you’re helping yourself in the future.”

By Meghan Edwards, digital content specialist for the ACR Bulletin

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