6 Practical Strategies for Moving to a Standards-Based Radiology Model
Moving to a standards-based model
A standards-based radiology model has two basic components: a premier subspecialty network of radiologists and a workflow technology system, according to Mr. Schlissberg and Dr. Seidelmann. The following strategies are possible only with these two components.
1. Be physician-led, professionally managed. One of the keys to success under a new radiology model is for the radiology group to be led by physicians but professionally managed, according to Dr. Seidelmann. In this leadership structure, the radiology group will be required to provide the infrastructure and management to deliver high-quality services at a lower cost.
2. Seek specialists across the country. To provide accurate reads for every study, radiology groups need access to a large subspecialty group. Dr. Seidelmann said hospitals should not limit themselves geographically, but instead search for radiologists across the country. These physicians can provide reads and consultations in real time via telemedicine and other technology. In the new model, 100 percent of subspecialty cases should be read by radiologists with expertise in the given area, Dr. Seidelmann said.
3. Provide internal nighttime coverage. Mr. Schlissberg and Dr. Seidelmann said using supplemental nighthawk services to provide coverage at night is too expensive and inefficient for the new radiology model. A hospital's radiology group should provide coverage throughout the night to eliminate the cost of a nighthawk group and its preliminary reads.
4. Ensure diagnostic accuracy for complex studies. To ensure diagnostic accuracy for complex studies, hospitals first need to identify the studies with the highest error rates and those that have a high probability of an error leading to patient mortality or morbidity. By evaluating each study on these dimensions, hospitals can identify the 10 most complex cases.
Hospitals should then design workflow processes to address these cases. Radisphere instituted three such changes:
• Send studies to the radiologists with the lowest error rates for those studies.
• Create alerts for radiologists when complex studies are ordered.
• Require a second radiologist to also read the study.
Through these changes, Radisphere's error rate for the top 10 complex cases dropped from 1.8 percent to 0.8 percent in three months.
5. Proactively manage inpatient test utilization. Unnecessary imaging generates costs and puts patients at risk due to the extra radiation exposure. Hospitals can manage inpatient test utilization in three ways:
• Point of care. Hospitals can prevent inappropriate utilization at the point of care using decision support tools to review all orders placed on inpatients. For example, if an ordered study is deemed inappropriate, the decision support system can notify the tech/transport staff not to scan the patient without further discussion.
• In advance and hard-coded. For studies most likely to impact the discharge decision, radiologists can prioritize the study to be read "stat," and a subspecialist can over-read the study to ensure diagnostic accuracy and limit follow-up imaging.
• Monthly analytics. By providing all physicians with normalized, national benchmarks on ordering patterns, hospitals can help physicians understand their utilization. Hospitals can proactively manage physician outliers with education and increased real-time scrutiny, according to Mr. Schlissberg and Dr. Seidelmann.
6. Manage episodes to reduce downstream cost. As the healthcare industry moves to a value-based system, hospitals can lower the cost of episodes of care by managing radiology utilization and ensuring diagnostic accuracy. For example, an accountable care organization can look at the top 50 episodes by total cost in which imaging plays a major role. By measuring the likelihood of a diagnostic error for these cases, hospitals can determine the top 10 episodes where radiology errors can lead to higher costs. Hospitals can implement protocols, such as automatically requiring these episodes to be double read, to ensure accuracy while eliminating unnecessary expense.
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