A Look Inside

Boosting value in your practice can be as simple as examining what you're already doing.A Look Inside

Value-based change is coming. It's a phrase you've heard for a while now, along with a host of acronyms and advice on how to make changes to your practice.

The opportunities are endless. But what if you are already performing value-based care and you — or your administration — just doesn't know it? It turns out an easy way to demonstrate value is measure, then improve what you're already doing.

Indiana University Health System's radiology department (IU) is no stranger to value-based care. Previously, the practice was featured in an Imaging 3.0 case study for its consultative approach to imaging appropriateness (ready more at bit.ly/IUImg3). IU maintains accreditation at each of its sites, and its practice actively participates in the RADPEER™ program. But one of its biggest projects has been a larger focus on quality improvement and assurance, which IU has been working toward since 2010.

IU radiology has ten subspecialty sections, and each is required to develop two quality programs throughout the year. These can serve a variety of goals — from improving imaging quality to reducing outpatient biopsy cancellation rates. Kenneth A. Buckwalter, MD, FACR, professor of radiology at IU and medical executive for IU Health Physicians, notes that IU radiologists have also begun improving the grammar and clarity of their reports because they know patients will be accessing them more frequently through patient portals.

Projects proposed in the fall and vetted by a quality and safety committee consisting of representatives from each radiology subspecialty. The committee then meets regularly to keep track of the projects and offer suggestions or advice.

At the end of the year, every member of the radiology team meets to discuss what worked with their projects and what didn't. "There's internal review about the quality of the project, and it's a great opportunity to learn from one another instead of being sequestered in our own sections," says Buckwalter.

And although everyone is on board right now, Buckwalter notes that at first it was difficult to get buy-in for teams across the institution. "It's a culture change, and that doesn't happen quickly," he says. So the program began slowly. The IU radiologists began with basic projects such as dose monitoring to get their feet wet and developed internal expertise on the best way to conduct and report projects in their setting.

The department also offered financial incentives in the form of a quality bonus for participating, says Jeffrey W. Dunkle, MD, Vice Chair of Clinical Affairs, in the IU Department of Radiology and Imaging Sciences. To receive the bonus, participants must meet specific metrics at individual, division, and department levels. They must also complete the required quality projects and have a representative from the group in attendance at 100 percent of the Quality and Safety Committee meetings. "We have found this incentive to be incredibly successful even though the dollars at risk are relatively modest," says Dunkle. Although the bonus was helpful at the start, now that the quality projects have been going for six years, Dunkle says the program is seen more as a part of everyday work rather than an extracurricular activity.

By doing these projects and emphasizing documentation, IU not only increases quality, but it also has a way to demonstrate this quality at all levels — to colleagues, the administration, and the public. And IU's hard work has paid off. At the staff level, the institution has created a culture change. "It's become ingrained in our culture to integrate quality improvement in our daily practice," says Dunkle.

"People are excited about the projects they're doing — IU has come a long way in six years," adds Buckwalter. IU is being recognized at the administration level as well. Scott D. Steenburg, MD, the director of the Quality and Safety Committee, received a Pillar Award for his efforts, one of the hospital system's highest honors.

IU's commitment to quality has also been recognized nationally — CMS' Transforming Clinical Practice Initiative (TCPi) selected IU has one of its best practice sites. TCPi was created by CMS to help physicians learn from mentors and peers. Because of the practice site nomination, IU's documentation and projects will be used as a model to help physicians nationwide incorporate value into their practice and showcase the value they are already creating. (Read about other radiology practices selected as best practice sites.

Buckwalter admits that the radiologists at IU were humbled at the nomination. "We're doing exactly what other radiologists are doing — we're looking at the changes to come and preparing for them," he says. And for those still looking to start preparing, Buckwalter notes it's not too late — and it's relatively easy. "Start measuring your activities. Just look at what you do and ask questions about how you can improve," advises Buckwalter. "All practices have room for improvement, but without measuring, you will never find those opportunities."

By Meghan Edwards, digital content editor for the ACR Bulletin

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