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Patient-centered Radiology Introducing Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America Rev 2014 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 * McGahan 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. * McGahan 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-the-art” technology, visual experience with in vivo pathology. * McGahan 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 (WebMD, 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 PATIENT-CENTERED EXPERIENCE Reception Caregiver Interactions http://www.hoaghospital.org/radiology/ 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, 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 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, Waiting. The New York Times. Sick and Scared, and Waiting, 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 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, 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? 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, entitlement mentality, addiction to pathological democracy Imaging services provider RadNet 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/JCAHO 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.RadiologyCares.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 pledge in support of patient-centered practices (no monetary donations) Resources At Your Fingertips: RadiologyInfo.org Provides patients with easy-to-understand information about radiologic tests, treatments and procedures ImageGently.org Information about reducing radiation dose during imaging of children ImageWisely.org Information about reducing radiation dose during imaging An Available Quality Patient Communication Resource: www.RadiologyInfo.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 both in 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 Results 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.