Breaking Barriers

Since its inception in 2012, the Harvey L. Neiman Health Policy Institute has been hard at work examining issues that affect all of radiology.breaking barriers

The recent changes in health care policy have been overwhelming — multiple payment procedure reduction, meaningful use, and the Affordable Care Act, just to name a few. These new programs define how imaging services and tools should be used and as well as their respective values.

However, much of the underlying research for these decisions has little or nothing to do with the field of radiology. Radiologists often do not have much of a voice in these matters, despite the fact that they, along with their patients, are greatly affected by the outcomes.

Bringing imaging specialists to the forefront of research is one of the aims of the Harvey L. Neiman Health Policy Institute (HPI). The institute provides credible, evidence-based research to inform the ongoing debates about health care and radiology's place in it, as well as to drive policy decisions. (Read more about the HPI's mission in "A True Picture of Radiology" at http://bit.ly/TruePicture.) "Radiologists should be the ones leading research on imaging so that the results and the clinical implications are as meaningful as possible," says Richard Duszak Jr., MD, FACR, chief medical officer of the HPI. "It's critical that we help change the way radiologists think about policy and the way that policy-makers think about radiologists."

Information Station

The HPI has released three policy briefs, a somewhat new concept for the medical field. Many health care publications undergo an intense peer-review process that takes many months or even years. However, policy briefs are intended to release thought-provoking ideas quickly. To this end, policy briefs are responsive and preliminary. They are published in order to fuel additional research and build out the literature on a topic. Later, these briefs are often followed by peer-reviewed papers that supplement the ideas expressed in policy briefs with more detailed data.

Slowing Trends

In October 2012, the HPI released its first brief, examining the slowdown and reversal of growth in medical imaging. Imaging had previously been rapidly growing for years, and the HPI believed it was necessary to alert policy-makers to the change as it was happening. Researchers found that their hypotheses were correct — they found a decline in imaging utilization and Medicare spending. The growth of imaging had not only slowed down but was decreasing. (To read a more in-depth summary of the brief, read "More or Less" in the January Bulletin at http://bit.ly/MoreorLess.) A companion paper, entitled "Trends in the Utilization of Medical Imaging From 2003 to 2011: Clinical Encounters Offer a Complementary Patient-Centered Focus," confirmed the slowdown of medical imaging with new datasets and was released in the July issue of the JACR®.

The HPI continues to demonstrate results on the slowing of growth in the imaging industry by publishing a related paper in December in conjunction with GE Healthcare researchers. This paper examines various policy trends and observes that, despite the fact that imaging was a very fast-growing component of health care cost in the late 1990s and early 2000s, the cost of imaging had rapidly declined. Co-written with health economist David Lee, the paper will appear in the American Journal of Roentgenologybreaking barriers in text 1

Repeat Performance

In February 2013, the next policy brief studied a framework for examining repeat imaging. The HPI was concerned that lawmakers and researchers were failing to consider the circumstances and timing in which imaging was being conducted — and therefore were labeling it unnecessary and duplicative. "We wanted to get people thinking about repeat imaging in a non-kneejerk way that would give a little bit of clarity to when imaging is and is not appropriately repeated. We also wanted to set a paradigm for other health services researchers to begin looking at this issue in different, more sophisticated ways," says Danny Hughes, PhD, research director of the HPI.

Right on the Money

The third policy brief, released in July 2013, examined health care costs and how the system might be able to move away from the fee-for-service model. It considered a more bundled, flat-rate approach to health care billing. The ideas in this policy brief are designed to allow radiologists to not only find a place at the center of health care delivery but also to help radiologists make recommendations on health care.

The HPI also published a paper in September's JACR on multiple payment procedure reduction (MPPR). CMS proposed the rule under the premise that repeated imaging creates a certain amount of efficiencies, and therefore any repeat imaging done in a certain time frame would receive a reduction in payment. The HPI was curious about CMS's methods for making this determination. The resulting paper went through the process of calculating the efficiencies for multiple images and found that, while minimal efficiencies do exist under these circumstances, they are highly variable and fall far below what CMS has proposed with the MPPR.breaking barriers in text 2

Sharing the Wealth

Another of the HPI's goals is to expand the base of researchers in imaging — not only to other radiologists but to academic institutions, health economists, and health services researchers as well. "There are great questions here," says Hughes. "Part of our goal is to ensure that not only do radiologists receive training to do policy-oriented research so that they have a voice but also to get non-radiologists interested in imaging as well."

Last year, the HPI sent out a call for proposals for ideas and questions concerning health care policy. Six grants were awarded — some were fully funded monetary grants, while others were supplemented by in-kind grants in which researchers were given access to the databases and analysts available through the HPI. The six grants represent a diverse group of researchers, ranging from a health services researcher in Oklahoma to clinical radiologists at the University of California at Los Angeles to a health economist from George Washington University. The HPI plans to do another call for proposals soon.

To continue the spread and growth of reliable and credible imaging research, the HPI will conduct a refresher course at the RSNA annual meeting to introduce attendees to health policy research; Duszak and Hughes will serve as faculty. The HPI is working with the ACR, RSNA, and the Association of University Radiologists to expand such educational offerings at future meetings.

On the Horizon

The HPI is also breaking barriers in research with the creation of the Imaging Inpatient Information (I3) app. I3 aggregates multiple years of Medicare inpatient claims data and allows the user to examine both hospital and imaging costs across inpatient Diagnosis Related Groups. Physicians can use the app to determine the average cost of all imaging services provided for specific inpatient episodes and benchmark their practice to improve performance — a helpful way to examine costs and potential payment plans as inpatient care continues to shift from fee-for-service models.

The I3 app will also be helpful to researchers examining the variation in spending among a variety of different conditions. As of press time, a beta version of the app is set to be released at RSNA.


By Meghan Edwards

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