Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America [ Insert organization name ] Rev 2015

Overview  Why should we, as radiologists, be patient-centered?  How can radiologists be patient centered?  Implementing patient centered practices: Practice management examples  Resources [ Insert organization name ]

Why Should We, As Radiologists, Be Patient-centered?

“…patients’ expectations have changed. Most patients want to talk with their health care providers and to play an active role in health care decisions. “…Yet despite revolutionary technological advances that are resulting in high-spatial-resolution anatomic imaging, radiologists are still entrenched in the historic cultural practice of communicating with referring physicians only and not with patients.” Gary M. Glazer, M.D., and Julie A. Ruiz, Ph.D. Radiology 2006; 241:11-16

“By default if not by design, the consumer is emerging as the locus of priority setting in healthcare.” JC Robinson, Ph.D., UC Berkeley

“To transform the current public misperception about our profession, the distance between patient and radiologist must be bridged. Patients acquire their value judgments largely through personal interactions with individual medical professionals.” Arl Van Moore Jr, M.D. Former Chair of the ACR Board of Chancellors

Statement 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.”

“Keeping medical imaging in the hands of physicians who treat patients is critical since it allows them to use their detailed knowledge of the patients’ medical history and specialized training to produce the most effective treatment plan possible.” Mark Gittleman, M.D.

He is a breast surgeon. “Keeping medical imaging in the hands of physicians who treat patients is critical since it allows them to use their detailed knowledge of the patients’ medical history and specialized training to produce the most effective treatment plan possible.” Mark Gittleman, M.D.

Why Should We, As Radiologists, Be Patient-centered?  Less than 50% of patients believe that radiologists are healthcare professionals who administer imaging tests  Less than 50% understand that radiologists are licensed physicians An ACR Survey in 2008 indicated that:

How Can Radiologists Be Patient-centered?

“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.” Harvey Neiman, M.D. ACR Bulletin 2002

How Can Radiologists Be Patient-centered? 1. Be visible to patients and referring clinicians

How Can Radiologists Be Patient-centered? By being visible, you: o Give radiologists a face and demonstrate the value-added service we provide for the healthcare team o Portray that radiologists are imaging experts and knowledgeable physicians o Show that radiologists are patient advocates o Demonstrate concern and knowledge about patient safety and radiation risks.

How Can Radiologists Be Patient-centered? 1. Be visible to patients and referring clinicians 2. Provide timely interpretation for patients and referring clinicians

How Can Radiologists Be Patient-centered? 1. Be visible to patients and referring clinicians 2. Provide timely interpretation for patients and referring clinicians 3. Consider giving results to patients in person

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. 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

Providing Results Directly To Patients Is Possible Survey of 261 patients:  92% wanted to be told of normal results by their radiologist  87% wanted to be told of abnormal results by their radiologist 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:

Providing Results Directly To Patients Is Possible  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:

 In 2003, there were 1,275,300 newly diagnosed cases of cancer, and 23,345 radiologists  Even if every case is diagnosed by a radiologist, that is one abnormal result per week per radiologist Reality Of Conveying Results American Cancer Society ( Pasko T, Smart D. Physician Characteristics and Distribution in the U.S. JAMA 2005; 1

 Is a privilege and a responsibility  Must be customized for each radiologist’s environment  Preferences of referring clinicians should be elicited prior to initiating a results-communication program  Is an important professional opportunity Reality Of Conveying Results

How Can Radiologists Learn To Be More Patient-centered? Participate In The Radiology Cares ® Campaign

Radiology Cares®: The Art of Patient-Centered Practice RadiologyCares.org 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.

Implementing Patient-centered Practices: Practice management examples

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Scheduling  Is the correct exam scheduled?  Are proper preparation instructions given to the patient?  How quickly can you get the patient into your office to be examined? o Back-logs will induce consumers to shop around for other providers  Do you offer web-based scheduling?  Registration, scheduling, and instructions must be a one-stop process

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Perception Is Reality… Waiting Room “LOUNGE”

Reception  Construct a “patient lounge” rather than a “waiting room”  Provide a concierge-like experience with a greeter during peak volumes  Attend to consumer inconveniences, such as unanticipated delays

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Caregiver Interaction  Technologists must have a consistent, friendly, professional demeanor  Does the patient get to talk to the radiologist before or after the exam?  Better yet, does the patient have an option to review with the radiologist?  Does the patient feel like they’ve received the best exam possible at an optimized/safe radiation dose?

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Results Reporting  Perhaps the most attractive area of opportunity for radiologists  With the appropriate information technology, patients should be able to walk out of the office with a copy of the report  Provide a cloud server image sharing service so patients can easily access and share images online  Make results electronically available and text or call patients when their report is ready

Results Reporting For Referring Clinicians:  Offer embedded images in the report  Provide a results notification system so that referring clinicians know immediately when their patients’ imaging results are available  Be readily available for questions regarding the results of a study

Patient-centered Radiology The components: PATIENT-CENTERED EXPERIENCE Scheduling Registration Reception Caregiver Interactions Results Reporting Billing

Billing  Notify patients of out-of-pocket expenses at time of scheduling  Accuracy of billing is a critical factor in becoming a high-performing, patient centered imaging center  Provide transparent pricing, as patients (healthcare consumers) will pay attention to price

Resources

  Radiologist resource for patient-centered care  Access to related scientific and consumer media articles and videos  Available customizable presentation decks

An Available Quality Patient Communication Resource:   Descriptions of over 200 procedures, exams and disease topics covering diagnostic and interventional radiology, nuclear medicine, radiation therapy and radiation safety  Reassures patients and saves physician time  Free, credible radiology information in easy-to-understand language  Tells your patients what to expect  Reviewed by radiologists (RSNA and ACR)  Available in both English and Spanish

“Success breeds persistence bordering on perseveration in what we do well despite very obvious threats, at the expense of adaptability and innovation. Innovation requires a conscious, purposeful search for opportunities.” Michael Brant-Zawadzki, M.D., and Robert Kerlan Jr., M.D. Academic Radiology. 2009

Promote And Practice Patient-Centered Radiology

Patient-centered Radiology Presentation Contributors  Mary C. Mahoney, M.D.  Matt Hawkins, M.D.  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.