1. Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America Patient-centered Radiology Rev 2014

2. Overview  What is patient-centered radiology?  Why should radiologists be patient-centered?  What does it mean to be focused on our patients?  Implementing Patient-centered Radiology: A Case Study and Lessons Learned  How can radiologists be patient-centered?  The Radiology Cares® Campaign

3. What Is Patient-centered Radiology?

4.  Standardized reporting of results  Two-way communication regarding results between radiologist and referring physician and between radiologist and patient  Realization that patient portals enhance the need for more user-friendly language when reporting results  Understanding the importance of patient engagement  Improved efforts regarding the level of care patients receive  Convey to patients the essential role radiologist have in patients’ healthcare and safety – to ensure patients understand that radiologists are more than just a name on a bill  Realize that many patients do not even know radiologists exist – patient-centeredness includes any efforts to improve that perception Patient-centered Radiology:

5. More than just talking to patients  It means we consider the patient experience holistically -- from scheduling through exam to reporting to billing to future communications  Assuring our patients we will do all we can to treat them as we would a loved one  As described by Richard B. Gunderman, M.D., Ph.D.: “We must see the patient behind the image.” Patient-centered Radiology:

6. “We, as radiologists, can begin to contribute by being public champions of this new patient-centered philosophy of care, and committing ourselves to putting patients at the center of everything we do.” George S. Bisset III, M.D. 2012 RSNA President President’s Address

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

8. Why Should Radiologists Be Patient-centered?

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

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

11. 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 patients 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

12. Key Observations About The Radiology Specialty  Radiology is successful!  Success breeds complacency – COMPLACENCY BLUNTS APPROPRIATE RESPONSE TO THREATS.  Success breeds persistence in what we do well (despite obvious threats), at the expense of adaptability and innovation.

13. 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

14. “… the invisibility of radiologists perpetuates the misperception that many imaging services are commodities.” “By offering an even higher level of personalized service through direct communication, radiologists can dispel this viewpoint by showing patients that they customize imaging examinations to fit each patient’s individual health care needs.” Gary M. Glazer, M.D. and Julie A. Ruiz-Wibbelsmann, Ph.D. The Invisible Radiologist. Radiology 2011; 258:1, 18-22 Consider:

15. ...cardiologists, orthopedists and others who want to do imaging  Coalition for Patient-Centered Imaging, American College of Cardiology, and other specialty associations Competition from other specialists Consider:

16. http://www.acc.org/advocacy/advoc_issues/imaging_021005.htm “ 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.” For Example, consider this excerpt from the Coalition for Patient-Centered Imaging :

17. ... “disruptive technology” that has potential to diminish need for or visibility of radiologists, e.g., teleradiology, CAD, PACS…. Example: Computer-aided detection (CAD) mammogram Developments in Our Technology Consider:

18. Eliminate Perception Of 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

19. 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, entitlement mentality, addiction to pathological democracy)  Imaging services provider RadNet of Los Angeles received a $110 million loan from GE Healthcare Financial Services (Reported in January 2008)

20. Time For A Change “… patients’ expectations have changed. Most patients want to talk with their health care providers and to play an active role in health care decisions.” “… radiologists are still entrenched in the historic cultural practice of communicating with referring physicians only and not with patients.” Glazer GM, Ruiz JA. The State of Radiology in 2006: Very High Spatial Resolution but No Visibility. Radiology. 2006; 241:11-16

21. 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?

22. Important Strategy Insight McGahan AM. How Industries Change. Harvard Business Review. October 2004  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

23. Radiology Core  Core activities: the production, interpretation and distribution of quality imaging studies of patients. Threatened by new outside alternatives. o Threats: competition from cardiologists, orthopedists and others who want to do imaging work (outside alternatives).  Core assets: independent, integrated subspecialty, whole body knowledge, brand name, early access to “state-of-the-art” technology, visual experience with in vivo pathology. Threatened by changes that diminish value. o Threats: disruptive technology that diminishes need for radiologists/imaging studies/equipment or supplants our diagnostic capability, e.g., teleradiology, CAD, genomics… (diminished value).

24. 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

25. 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 Change Trajectory

26. 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

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

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

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

30. Why Be More Patient-centered?  We are physicians; professionals  Maintenance of certification (MOC) requirement  We’ve been “invisible” too long  Competition from other specialties  It is what patients (and payors) want  Rendered anonymous by our own technology

31. What Does It Mean To Be Focused On Our Patients?

32. Put Patients First  Minimize delays  Increase communication  Create a welcoming environment of caring, responsive people

33. Perception Is Reality… Waiting Room “LOUNGE”

34. What Patients Want Lessons from Colon Screening Experience:  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!

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

36. 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

37. 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

38. 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

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

40. 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

41. 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

42. 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

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

44. 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

45.  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 Billing Accuracy: Related To Patient Satisfaction A Case Study Lessons learned

46. How Can Radiologists Be Patient-centered?

47. Be Visible  Meet and greet  Discuss results  Make the radiologist-as-physician connection with your patients  Give radiologists a face and a value as part of the healthcare team

48. 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.

49. 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. Patients expect timely results

50. What Radiologists Need To Do:  Differentiate your practice  Provide great local services  Provide personal service

51. 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

52. 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

53. Develop Patient-centered Communications Dear Patient: 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 > 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 >>>>. To schedule your next appointment, call >>>>. We look forward to providing imaging services for you again. Sincerely, The Physicians of Newport Harbor Radiology Associates Example of a Patient-centered Letter to Patients with emphasis on Radiologist involvement

54. 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

55. 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! 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

56. 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. Lessons Patients Learn From Talking With Radiologists

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

58. 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

59.  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

60.  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 Trepidation Of Disclosure Unfounded Radiologists need not be afraid of disclosure!

62.  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 What Is Radiology Cares?

63. Vision Patients are the primary focus of radiologic care. Mission The Radiology Cares® campaign mission is to encourage and facilitate radiologists’ meaningful engagement in the patient experience.

64. Goals To promote:  Alignment of radiology practice with patients’ needs and best interests.  Optimal patient experience throughout the continuum of their radiologic care.  Effective communications with patients and other healthcare providers, thus empowering patients to make informed decisions regarding their medical care.

65. MODEL OF CARE

66.  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 Radiology Cares® pledge in support of patient-centered practices

67. 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

68. 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

69. Resources At Your Fingertips:  RadiologyCares.org  RadiologyInfo.org  ImageGently.org  ImageWisely.org

70. 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 in both English and Spanish

71. 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 radiologycares@rsna.org

72. 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.