1. Patient-centered Radiology
Sponsored by the Patient-Centered Radiology Steering Committee of the Radiological Society of North America
Rev 2015

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. Patient-centered Radiology:
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

5. Patient-centered Radiology:
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.”

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

8. Why Should Radiologists Be Patient-centered?

9. “Professionalism is the basis of medicine’s contract with society
“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

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

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. Consider:
“…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

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

16. For Example, consider this 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.”

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

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
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:
Threats to industry’s core activities
Threats to industry’s core assets
McGahan AM. How Industries Change. Harvard Business Review. October 2004

23. Radiology Core
Core activities: the production, interpretation and distribution of quality imaging studies of patients. Threatened by new outside alternatives.
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.
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. 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

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

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

36. Background On Hoag Hospital
A Case Study
Background On Hoag Hospital
498-bed acute care not-for-profit hospital
Joint Commission 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

37. Accuracy Of Appointment
A Case Study
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

38. A Case Study
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

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

40. Measure The Steps… Focus On Sources Of Variability
A Case Study
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

41. Report Turnaround Times
A Case Study
Report Turnaround Times
Hoag Hospital report turnaround time = 99% less than 8 hours
Best in Class benchmark less than 4 hours
< 8 hours 10%
< 4 hours 15%
< 1 hour 12%
< 5 minutes 63%
Data source: Hoag Hospital CPOG report Jan-Dec 2005

42. Patient Delays And Wait Times
A Case Study
Lessons learned
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

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

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

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

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. Patients expect timely results
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.’”
Patients expect timely results
Kolata G. (2005). Sick and Scared, and Waiting, Waiting, Waiting. The New York Times.

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
Example of a Patient-centered Letter to Patients with emphasis on Radiologist involvement
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 <<(949)xxx-xxxx>> 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 <<<<fill in>>>>>. To schedule your next appointment, call <<<< fill in>>>>> . We look forward to providing imaging services for you again.
Sincerely,
The Physicians of Newport Harbor Radiology Associates

54. Added Value/Competitive Advantage Of On Site Radiologists
Supervision of equipment, choices, discounts
Quality control / peer review / Joint Commission 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:

56. Lessons Patients Learn From Talking With Radiologists
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.

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

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:

59. 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:

60. Trepidation Of Disclosure Unfounded Radiologists need not be afraid of disclosure!
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 (
Pasko T, Smart D. Physician Characteristics and Distribution in the U.S. JAMA 2005; 1

62. 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

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

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
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

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:
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

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

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.