Patientcentered Radiology Introducing Sponsored by the PatientCentered Radiology

Patient-centered Radiology Introducing Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America Rev 2016

Overview § Are radiologists patient-centered? § What does it mean for a Radiologist to be focused on patients? § How are Radiologists trying to become patient-centered? § How can Physicians help Radiologists be more patient-centered… and how can you help? § Discussion

Are Radiologists Patient-centered?

“Professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician. . . ” Excerpt from Medical Professionalism in the new millennium: A Physician Charter ABIM Foundation ACP-ASIM Foundation European Federation of Internal Medicine

The Doctor-Patient Relationship § Built on familiarity and trust § The foundation of the place and influence of physicians in society § Not traditionally developed in radiology, except for interventional services Glazer GM, Ruiz JA. The State of Radiology in 2006: Very High Spatial Resolution but No Visibility. Radiology. 2006; 241: 11 -16

Maintenance Of Certification (MOC) Fulfills 3 of 6 competencies required for MOC: § Interpersonal and communication skills § Patient care § Professionalism

Important Strategy Insight § Postulate: An organization’s strategy cannot succeed unless it is aligned with the industry’s change trajectory. § Def: The change trajectory is determined by two threats of obsolescence: o Threats to industry’s core activities o Threats to industry’s core assets * Mc. Gahan AM. How Industries Change. Harvard Business Review. October 2004

Radiology Core § Core activities: activities that have historically generated profits for the industry; threatened by new outside alternatives. * o For radiology: the production, interpretation and distribution of quality imaging studies of patients. * Mc. Gahan AM. How Industries Change. Harvard Business Review. October 2004

Radiology Core § Core assets: resources, knowledge, and brand capital that have historically made the organization unique; threatened by changes that diminish value. * o For radiology: independent, integrated subspecialty, whole body knowledge, brand name, early access to “state-of-theart” technology, visual experience with in vivo pathology. * Mc. Gahan AM. How Industries Change. Harvard Business Review. October 2004

Developments In Our Technology. . . “disruptive technology” that has potential to diminish need for or visibility of radiologists, e. g. , teleradiology, CAD, PACS….

What Patients (And Others) Want § Patient-centered care promoted by the Centers for Medicare & Medicaid Services (CMS) and many others § Metrics exist and are being developed § Practice performance is a matter of public record

CAHPS Consumer Assessment of Healthcare Providers and Systems § www. cahps. ahrq. gov § Health care quality information from the consumer perspective § 27 -question survey developed and cleared for public use January 2006 § Data published beginning of 2008 § ABMS incorporated CAHPS patient survey into MOC standards

Some CAHPS Survey Topics Relevant To Imaging § Communication with doctors § Communication with nurses § Responsiveness of staff § Discharge information

Change Trajectory Politics, medical industry, Internet culture pushing patients towards more self reliance: § Payor/physician culture is excessively paternalistic, controls the practice of medicine and patient referral § Restricted access § Patients distrust system, sense managed costs, not managed care

The End Of Managed Care “By default if not by design, the consumer is emerging as the locus of priority setting in healthcare. ” James C. Robinson, Ph. D. , M. P. H. Chair, Berkeley Center for Health Technology, University of California, Berkeley The end of managed care. JAMA 2001 May

Change Trajectory Mainstream medicine is becoming consumer driven: § High deductible health insurance, HSAs § Patients have access to medical information and suggested treatment (Web. MD, TV, print ads, etc. ) § Direct patient marketing by pharmaceutical companies, doctors, hospitals, university medical centers § Self-medication with over-the-counter, non-prescription items § Self-referral for mammograms, UAE, coronary CTA increasing § $50 billion alternative medicine industry

Radiologist As A Patient-centered Physician § We are physicians, professionals § Maintenance of Certification (MOC) requirement § Can no longer afford to be “invisible” § Rendered anonymous by our own technology § Mainstream medicine’s Patient-Centered Medical Home § What patients (and payors) want

What Does It Mean For A Radiologist To Be Focused on Patients?

Lessons From Colon Screening: Patients Want… § Easy appointment access § Information content of study § “Face Time” with doctor § Rapid feedback § Reassurance or rapid triage § Cost flexibility § Transparent pricing and billing § Self-reliance… greater degree of control!

Patient-centered Radiology Components: Scheduling Registration Billing Results Reporting http: //www. hoaghospital. org/radiology/ PATIENT-CENTERED EXPERIENCE Reception Caregiver Interactions

Putting Patients First § Minimize delays § Increase communication § Create a welcoming environment of caring, responsive people

How Are Radiologists Trying To Become Patient-centered?

Being More Visible § Meet and greet § Discussing results § Make the radiologistas-physician connection with your patients § Becoming a recognizable part of the healthcare team

Sick and Scared, and Waiting, Waiting By Gina Kolata Published: August 20, 2005 “Freddie Odlum spent two terrible days waiting by the phone for her doctor to call. She had a CT scan to investigate a suspicious mass in her lungs and Ms. Odlum, a Los Angeles breast cancer patient, was all too aware that if the cancer had spread, her prognosis would not be good. “But her doctor did not call [for several weeks]. … The scan did not show cancer, but she could not forgive her doctor. ‘This internist had been my family doctor for years, ’ Ms. Odlum said. … ‘I never spoke to him again. ’” Kolata G. (2005). Sick and Scared, and Waiting, Waiting. The New York Times.

Sick and Scared, and Waiting, Waiting By Gina Kolata Published: August 20, 2005 “Freddie Odlum spent two terrible days waiting by the phone for her doctor to call. She had a CT scan to investigate a suspicious mass in her lungs and Ms. Odlum, a Los Angeles breast cancer patient, was all too aware that if the cancer had spread, her prognosis would not be good. Patients expect timely results “But her doctor did not call [for several weeks]. … The scan did not show cancer, but she could not forgive her doctor. ‘This internist had been my family doctor for years, ’ Ms. Odlum said. … ‘I never spoke to him again. ’” Kolata G. (2005). Sick and Scared, and Waiting, Waiting. The New York Times.

Radiologists Can Help Ease Your Patients’ Concerns § Direct communication with patient about: The diagnostic process o Purpose for the exam o Radiation concerns o Important finding o § Direct communication with you about: o Urgent or unexpected findings

Direct Communication Of Results § In some practices, radiologists can discuss results of imaging studies directly with the patient § Close communication between the radiologist and the referring physician is needed for this process to succeed

Lessons Patients Learn From Talking With Radiologists § Radiologist as Imaging Expert, Knowledgeable Physician § Radiologist as Patient Advocate § Radiologist as Gatekeeper § Radiologist as Referring Physician

Lessons Patients Learn From Talking With Radiologists § Direct communication between the radiologist and the patient allows the patient to ask questions and may provide the radiologist with important historical information

Patients Want Results From Radiologists Survey of 261 patients: § 92% wanted to be told of normal results § 87% wanted to be told of abnormal results Schreiber MH, Leonard Jr M, Youmans Rieniets C. Disclosure of Imaging Findings to Patients Directly by Radiologists: Survey of Patients’ Preferences. American Journal of Radiology 1995; 165: 467 -469

Trepidation Of Disclosure Unfounded § Majority of test results are normal, or do not indicate life threatening conditions § 96% of 287 patients: test normal, or non-malignant condition Vallely SR, Manton Mills JO. Should Radiologists Talk to Patients? British Medical Journal 1990; 300: 305 -306

Abnormal Results If you prefer to reveal abnormal results to your patients personally: § Develop a relationship with your local radiologist § Collaboratively create a script that allows the radiologist to convey important findings in a manner consistent with your patient’s needs

What Are Radiologists Doing To Become More Patient-Centered? And How Can You Help?

Radiologists Are Reducing the Pain of Uncertainty By Gina Kolata Published: November 24, 2014 “…patients are more insistent on knowing how and why doctors make decisions about their care. And more and more medical centers and doctors’ offices are allowing patients to log on and see their medical records, which can include reports on scans. “But many people never consider asking to speak to a radiologist and many doctors seem to have no relationships with radiologists – they just hand patients a prescription for a scan…. “Yet patients want to hear from radiologists…. ” Kolata G. (2014). Radiologists Are Reducing the Pain of Uncertainty. The New York Times.

Improving Exam Scheduling § Ensuring that the correct exam is scheduled o Requires good clinical information on the request § Appropriate exam preparation instructions o Have your office staff ask about preps § Explaining the timing of the exam § Ensuring that physician orders are received and correct o Lost or delayed orders result in patient dissatisfaction

Keeping Backlogs To A Minimum § Most centers try to accommodate patients within 2 days § Patient reminder calls

Turnaround Times § Most radiology practices are monitoring time from order to final report § Technology has improved radiology report generation o PACS o Computer-based information systems o Voice recognition dictation o Standardized reporting o Urgent findings notification systems

Radiology As Commodity: Drivers § Consumer Driven Care § PACS/Teleradiology § § o CAD o Demystification of the technology o In-office clinician imaging o Corporatization of Radiology Internal Factors o Volume per FTE: The Time/Money Dynamic o Lack of Sub-specialization o Nighthawk o Radiologist “Culture” (life style, entitlementality, addiction to pathological democracy Imaging services provider Rad. Net of Los Angeles has received a $110 million loan from GE Healthcare Financial Services (Reported in January 2008)

Risks Of Teleradiology § Diminishes contact between the interpreting radiologist and the patient § May decrease your ability to know the qualifications of the radiologist interpreting your patient’s images

Added Value/Competitive Advantage Of On Site Radiologists § Supervision of equipment, choices, discounts § Quality control / peer review / Joint Commission standards & credentialing § Participation in medical staff governance § Participation in hospital operations § Involvement in strategic planning § Attendance at organizational meetings § Promotion of services

Take Advantage Of The Radiologist’s Medical Imaging Expertise! § Communicate with your radiologists o Find out about their special skills and practices § Invite them to participate in multidisciplinary conferences and rounds § Call them for questions about: o o o appropriateness of exams radiation safety newly available imaging modalities and interventional procedures

What Is Radiology Cares®? § Patient-centered Radiology initiative § Launched at RSNA 2012 § Represents years of evolution of refresher courses, meetings, workshops § Overseen by the RSNA Patient-Centered Radiology Steering Committee

§ www. Radiology. Cares. org § Radiologist resource for patient-centered care § Access to related scientific and consumer media articles and videos § Available customizable presentation decks

Caring Quilt: Messages from Our Patients Illustrates radiology’s impact on patient care by highlighting patients’ expressions of appreciation for the radiology professionals who went above-and-beyond in caring for them. www. rsna. org/The-Caring-Quilt

Resources At Your Fingertips: § Radiology. Info. org Provides patients with easy-to-understand information about radiologic tests, treatments and procedures § Image. Wisely. org Information about reducing radiation dose during imaging § Image. Gently. org Information about reducing radiation dose during imaging of children

An Available Quality Patient Communication Resource: § www. Radiology. Info. org § Descriptions of over 200 procedures, exams and disease topics covering diagnostic and interventional radiology, nuclear medicine, radiation therapy and radiation safety § Reassures patients and saves physician time § Free, credible radiology information in easy-to-understand language § Tells your patients what to expect § Reviewed by radiologists (RSNA and ACR) § Available in both English and Spanish

Patient-centered Future Initiatives § One-stop registration and scheduling to include Web-enabled appointment access for patients and referring physicians § Patient-accessible Web page Ø Results Ø Consult with a radiologist § All patients requiring radiology services will be able to schedule their appointments (or drop in), have their exam completed and their report available to their physician all within the same working day § Patients leave imaging center with results § Greater radiologist / patient interaction

Presentation Contributors § Philip O. Alderson, M. D. § Michael Brant-Zawadzki, M. D. § Marcy A. Brown, A. R. R. T § Carol M. Rumack, M. D. § Eric J. Stern, M. D. § Joseph H. Tashjian, M. D. § Susan D. John, M. D. § Harvey L. Neiman, M. D.