Sponsored by the PatientCentered Radiology Steering Committee of

Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America [ Insert organization name ]

[ Insert organization name ] Overview § Why should radiologists be patient-centered? § What does it mean to be focused on our patients? § How can radiologists be patient-centered? § Implementing Patient-centered Radiology: A Case Study and Lessons Learned § Resources § Discussion

Why Should Radiologists Be 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

Doctor-Patient Relationship § Traditional, built on familiarity and trust § The foundation of the place and influence of physicians in society Yet it’s: § Weak to non-existent in radiology 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 3 of 6 competencies required for MOC: § Interpersonal and communication skills § Patient care § Professionalism

Radiology Core Assets § § § § Independent Integrated subspecialty Whole body knowledge Brand name Use of “state-of-the-art” technology Visual experience with in vivo pathology Disruptive technology threatens value: teleradiology, CAD, tiny ultrasound machines, office CT

Radiology Core Activities § Production of images § Interpretation of images § Distribution of quality imaging studies of patients § Alternative providers threat from cardiologists, orthopedists, and others who want to do imaging § “Coalition for Patient-Centered Imaging”: American College of Cardiology and about 15 other specialty associations

For example, consider this excerpt from the Coalition for Patient-Centered Imaging: “The Coalition represents the undersigned healthcare organizations committed to ensuring that patients have full access to high quality, convenient, and up-to-date imaging technology… organized in response to efforts to limit the availability of imaging services provided in physicians’ offices… such as obstetricians/gynecologists, neurologists, orthopedic surgeons, cardiologists and urologists. ” http: //www. acc. org/advocacy/advoc_issues/imaging_021005. htm

Rise Of The Patient-Centered Medical Home Model Great deal of momentum for reshaping the payment environment around a primary care model: § “The Patient-Centered Medical Home” § Policies that promote personal, holistic and coordinated care for all will result in better value and improved health § Patient-centered “convenience is key” § Being pursued by business community, purchasers, payors and patient advocate groups

Patient-centered Primary Care Collaborative Examples of Broad Stakeholder Support and Participation AAMC Annual Meeting Nov 2008

Patient-Doctor Relationship Patient-Centered PRIMARY CARE Collaborative: “A long-term comprehensive relationship with your personal physician empowered with the right tools and linked to your care team can result in better overall family health…” AAMC Annual Meeting Nov 2008

What Patients (And Others) Want § Patient-centered care promoted by 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

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. Mc. Gahan AM. How Industries Change. Harvard Business Review. October 2004

Change Trajectory Politics, medical industry, Internet culture pushing patients toward 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

Why We Should Be Patient-centered § We are physicians, professionals § Maintenance of certification (MOC) requirement § We’ve been “invisible” § Competition from other specialties § Rendered anonymous by our own technology § Mainstream medicine’s Patient-Centered Medical Home § What patients (and payors) want

What Does It Mean To Be Focused On Our Patients?

Time For A Change “It’s time we adjust our perception of how we see ourselves and, more importantly, how we’re seen by the medical community and general public. We need to vigorously promote ourselves in order to attract referrals from primary care physicians and those patients who are self-referred. We must change the perception that we are consultants only and demonstrate our ability to provide complete patient care. ” Neiman HL. ACR Bulletin 2002; 58: 6.

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 The components: Billing Results Reporting http: //www. hoaghospital. org/radiology/ Scheduling Registration PATIENT-CENTERED EXPERIENCE Reception Caregiver Interactions

Perception Is Reality… Waiting Room “LOUNGE”

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

How Can Radiologists Be Patient-centered?

Being Visible § Meet and greet § Discuss results § Make the radiologistas-physician connection with your patients § Give radiologists a face and a value as 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.

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 Patient communication can take the radiologist from the back room of doctor-to-doctor consultation to the front office of DIRECT patient-centered care and clinical medicine.

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, et al. 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

Trepidation Of Disclosure Unfounded Radiologists need not be afraid of disclosure! § In 2003, 1, 275, 300 newly diagnosed cases of cancer, and 23, 345 radiologists § Even if every case is diagnosed by a radiologist, that’s one abnormal result per week per radiologist American Cancer Society (http: www. cancer. org) Pasko T, Smart D. Physician Characteristics and Distribution in the U. S. JAMA 2005; 1

Dear Patient: Patient Letter Example Thank you for choosing Newport Harbor Radiology Associates. We are the physicians who perform and interpret the procedure you had today. You can be assured that a board certified radiologist, one of our group’s expert sub-specialist physicians, supervised and interpreted your procedure today. The results of your procedure are being forwarded to the physician who referred you for this procedure. If you have any questions, consultation with your physician will be of value. Should you need further clarification, feel free to contact us. Our radiologists are acknowledged experts in their field, some of our doctors having pioneered many of the radiology procedures being performed today. We aim to provide the highest possible level of care in a sensitive and patient oriented environment. We provide consultation not just to your doctor, but to other radiologists and physicians from outside this region, and help educate such physicians in the latest and most appropriate techniques tailored to a given diagnostic and therapeutic need … We staff Newport Imaging Center, and all of Hoag Hospital’s Radiology facilities. If you require a copy of the results for your files, or a copy of the images themselves on CD, please let us know. You can make this request at the front desk or by calling <<(949)xxx-xxxx>> and our staff will make these arrangements for you. Newport Harbor Radiology Associates offers the most advanced, comprehensive imaging services, radiological studies, and image guided treatments in all of California. To learn more, visit our web site at <<<<fill in>>>>>. To schedule your next appointment, call <<<< fill in>>>>>. We look forward to providing imaging services for you again. Sincerely, The Physicians of Newport Harbor Radiology Associates

Voice Recognition And Self-Edit Reporting § Accurate, standardized, understandable reports provided in the fastest time possible. § Whose responsibility? You are the master of your final product! o Careful editing is required to avoid content and typographical errors o Editing by transcriptionists may be an option for some practices o Templates and standardized reports are helpful 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

What Radiologists Need To Do § Differentiate your practice § Provide great local services § Provide personal service

Implementing Patient-centered Radiology: A Case Study & Lessons Learned Hoag Memorial Hospital Presbyterian Newport Beach, California

A Case Study Background On Hoag Hospital § 498 -bed acute care not-for-profit hospital § JCAHO accredited § Designated Magnet Hospital § Distinguished Hospital Award for clinical excellence and patient safety § 338, 000 imaging studies performed in 2008 § 386 radiology employees and 27 radiologists § 7 outpatient imaging centers § State-of-the-art Breast Care Center

A Case Study Accuracy Of Appointment § Correct exam scheduled? § Preparation given to patient? § Arrival time and exam time explained? § Right time, right location, right preparation? § Lost physician orders = Loss in patient confidence

A Case Study Patient Access § Outpatients are likely to seek alternate provider if backlog is greater than 2 days § Backlogs can drive no-shows § No-show rates may be higher than you think § Revenue opportunity is significant with backlogs

A Case Study Reception § Greeter during peak volumes § Manage patient arrivals § Improve waiting room environment § Invite patients to inquire about delays

A Case Study Measure The Steps… Focus On Sources Of Variability § Radiologist speed § Workload § Number of radiologists on duty § Number of transcribers (editors) on duty § Track radiologist variables that can lead to overall backlogs and failures § Implement voice recognition solution

A Case Study Report Turnaround Times § Hoag Hospital report turnaround time = 99% less than 8 hours § Best in Class benchmark less than 4 hours o < 8 hours 10% o < 4 hours 15% o < 1 hour 12% o < 5 minutes 63% Data source: Hoag Hospital CPOG report Jan-Dec 2005

A Case Study Lessons learned Patient Delays And Wait Times You can’t manage what you can’t measure § Reduce bottlenecks § Apply same rigor to add-on and walk-in patients § Patients deserve to know why they are waiting § Improve exam start time

A Case Study Lessons learned Understand Your Customer’s Expectations Inform the patient when they should expect their exam results

A Case Study Lessons learned Billing Accuracy: Related To Patient Satisfaction Accuracy of charges: Correct billing is a critical factor in becoming a high performing patient-centered radiology department. § Verification of authorization prior to performing exam § Check outstanding balances, contact patients for payment prior to visit

A Case Study Lessons learned Billing Accuracy: Related To Patient Satisfaction § Notify patients of out-of-pocket payments at time of scheduling § Patients deserve to know the cost and quality of the product § Increased consumer interest in price shopping will influence choice of facility

Change Isn’t Easy… Especially Cultural Change § Culture eats strategy for lunch… § But good management can change culture § And, it’s time for a change! Why?

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

Radiology As Commodity § Nighthawk: Removes you from the point of service § Delegation of services to faceless provider § “Anyone can do this” § Devalues work effort § Exposes the high margin – promotes price competition

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

Position Yourself As The Medical Imaging Expert! § Communicate with your referring physicians § Use Tumor Boards/interdisciplinary opportunities to embed as an essential member of team § We are honest brokers – responsible medical imagers without vested interests. Describe yourself that way

Patients Ask: What’s So Special About Radiologists? § Radiologists take a more responsible safety stance toward lifetime radiation dose § Radiation dose and patient safety: we know about it, we tell you about it, and we practice it § We have the highly specialized training and expertise to know the right test, when to order it, and how to interpret it

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

MODEL OF CARE

§ www. Radiology. Cares. org § Radiologist resource for patient-centered care § Access to related scientific and consumer media articles and videos § Available customizable presentation decks § Source to take the Radiology Cares® pledge in support of patient-centered practices

Resources At Your Fingertips § Radiology. Info. org § Image. Gently. org § Image. Wisely. org

An Available Quality Patient Communication Resource: § www. Radiology. Info. org § Reassures patients and saves physician time § Free, credible radiology information in lay language § Over 135 radiologic procedures and disease/condition descriptions § Tells your patients what to expect § Reviewed by radiologists (RSNA and ACR) § Available in both English and Spanish

Enhance Visibility Of Radiologists § Get out in front! § Post photos of radiologists in hospitals § Include radiologists’ signatures on patient reports § Give patients your card (with home phone!) § Call your patients – make direct referrals

Patient-centered Future Initiatives § One-stop registration and scheduling to include Web-enabled appointment access for patients and referring physicians § Patient-accessible Web page o Results o 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

Spread The Word About Patient-centered Radiology § Meet your patients § Contact your referring physicians § Convince your radiologist peers about the importance of patient interaction § Present this customizable talk to your colleagues

Tell Us Your Stories… § Describe clinical scenarios where your patient interaction was meaningful to the patient and the medical outcome § Tell us about your successful patient–centered radiology programs. How do you practice it? § Send stories and examples to RSNA at radiologycares@rsna. org

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.