Interview w/: Keith Chew, MHSA, CMPE, Pres. RBMA
Keith E. Chew, MHSA, CMPE, President of the Radiology Business Management Association, discusses his observations on current and future trends in imaging and radiology.
Radiology probably doesn’t get its fair share of the glory that therapeutic medical specialties enjoy. In fact, one could argue that the only time a radiologist ever gets substantial recognition is when he or she makes a mistake. Now radiology and imaging are getting attention from payors, and the new focus on value-based quality metrics has proven rather difficult to apply to these disciplines.
“Imaging finds itself in a different position than other specialties,” says RBMA President Keith Chew. “Most specialties can point to very specific quality measures in their diagnostic or therapeutic procedures. The problem is that imaging engages with aspects of all specialties—it is a truly consultative service. Patients are referred for medical imaging services, so no one walks into the radiologist and says I hurt here, or I feel different in the following way – what’s wrong with me?”
The current view of radiology and imaging services places great emphasis on fellowship training, turnaround times, and other non-outcome based measures. However, Chew is concerned that these current metrics will not move medical imaging toward the best path for the future. Patient satisfaction is also not an ideal measure because it places a great deal of emphasis on each patient’s personal expectations. Two patients receiving the same exact imaging service could report satisfaction levels at opposite extremes purely based on their different personal expectations.
“If medical imaging quality metrics are just a checklist that lack insight into the resulting patient outcomes, it could force medical imaging into a commoditization role,” warns Chew. “It has to be more, it has to encompass the outcomes patients experience from the entire care process and the contribution medical imaging makes to that outcome. ACR and RBMA are trying to develop meaningful quality metrics. If the profession doesn’t, metrics will clearly be forced upon it and those metrics will be developed by individuals less knowledgeable about the positive impact medical imaging can play in improving patient outcomes. It is an area in which we’re all greatly concerned.”
Alternatively, Chew foresees a possible alternative path for the industry in which radiologists reestablish themselves as more recognized valued members of the patient care team. This could be accomplished by establishing metrics which focus on the improvements medical imaging could contribute to patient medical outcomes, and the advantages of getting patients into appropriate therapeutic phases more quickly once the appropriate diagnostics have been performed.
“Radiologists used to be the physician’s physician,” explains Chew. “Radiologists deal with every body system and a vast array of disease process daily. Every radiologist talks to a number of different physician specialists every day. Their knowledge truly transcends all body systems.”
Chew says radiology is uniquely positioned to take some of the variance out of diagnostics. He cites how the Fleischner study of lung nodules and Duke Radiology’s study of thyroid nodules both created guidelines for appropriate treatment and follow-up associated with medical imaging diagnostic findings correlated with the clinical symptomology of the patient.
“When you look at a lung and you see a nodule, the characteristics of that nodule may mean very different things from a diagnostic perspective,” says Chew. “Prior to the Fleischner study, follow-up at different levels was conducted on most if not all of these nodules. But now there are evidence based protocols to provide better guidance on the type of follow-up necessary to bring about the best medical outcome.”
The Duke Radiology study performed a retrospective 10-year review of medical data and found that adopting certain follow-up guidelines for incidental thyroid nodules would result in very few thyroid cancers being missed, while eliminating 30% of biopsies. Prior to the Fleischner and Duke studies on incidental nodules, there was very little research correlating the diagnostic radiographic findings and synthesizing guidelines for how to proceed from a treatment standpoint.
|
Duke’s 3-Tiered System |
|
| CT/MRI/PET-CT Features | Recommendations |
| Category 1: Thyroid nodule PET avid or Thyroid nodule locally invasive or Suspicious lymph nodes | Strongly consider workup with US for any size nodule |
| Category 2: Solitary thyroid nodule in patient <35 years of age. | Consider workup with US if >1 cm in adults. Consider workup with ultrasound for any size in pediatric patients. |
| Category 3: Solitary thyroid nodule in patient >35 years of age. | Consider workup with ultrasound if >1.5 cm. |
| Multiple nodules | Consider ultrasound with recommendations prioritized on basis of criteria (in order listed) for solitary nodule. |
This type of research was very difficult to perform before the advent of electronic medical records. Thousands of patient records had to be manually retrieved and reviewed. Now that the technology has made the data more accessible, radiologists, in conjunction with other medical specialists, are in a position to develop the guidelines for the next steps of care when the performance of a diagnostic imaging exam results in specific findings of interest.
“In my thought process, we are trying to correlate the diagnostics from an imaging exam with the best possible medical outcome for a patient and ultimately the population. If we are able to garner the appropriate data and transform the data into actionable information, we can add specificity through the medical imaging exams to the next steps both diagnostically and therapeutically to aid in improving the medical outcomes of patients,” says Chew.
If better value propositions for radiology and imaging can’t be established, Chew warns, “We run the risk of becoming totally commoditized. We basically become nothing more than a box of screws on a hardware shelf.”
————————————————-
Keith E. Chew, MHA, CMPE, is a Senior Vice President Integrated Medical Partners, Managing Director of Strategic Positioning and Consulting Services Integrated Radiology Partners, and President of the Radiology Business Management Association. He can be reached by email at Keith.Chew@IntegratedMP.com.