Can advances and efficiencies in digital radiography (DR) technology improve patients’ perceptions of the x-ray department—and, in the process, help boost hospitals’ HCAHPS scores—ultimately leading to smarter marketing, maximized reimbursement and increased patient volume?
In a word, Yes.
That’s according to Gregg R. Cretella and Bill Nicholas of Stamford, Conn.-based FUJIFILM Medical Systems U.S.A., Inc.. Cretella is the company’s national manager of image quality, Nicholas its product manager for DR systems. They presented a compelling case for achieving all of the above, and more, in a session at the 2015 annual meeting of the Association for Medical Imaging Management in Las Vegas this summer.
|Bill Nicholas, FUJIFILM Medical Systems USA|
Nicholas led with a brief recap of the pair’s 2013 AHRA presentation, in which they began the process of equating HCAHPS patient-satisfaction measures, part of the domains of care in Medicare’s Value-Based Purchasing (VBP) program, with radiology-specific domains of care.
He noted that diagnosis-related groups (DRG) base operating payments are being adjusted up or down, for incentives or penalties, year by year. In 2013, the adjustment was 1 percent and weighted for just process of care (70 percent weight) and HCAHPS (30 percent weight). By 2017, the swing will be 2 percent, and payments will be weighted for clinical care outcomes/process (25 percent weight, 5 percent weight), efficiency and cost reduction (20 percent weight), safety (20 percent weight) and patient/caregiver experience (25 percent weight).
“We wanted to equate those two 2013 perceptions, process of care and HCAHPS, to radiology because at that time, there were no such perceptions,” he said.
|Gregg R. Cretella, FUJIFILM Medical Systems USA|
Cretella illustrated how this played out in practice. “In 2013 our goal was to correlate, as an example, nurse communications, which is an actual HCAHPS measure, to something that the patient and the x-ray department may encounter,” he said. “So in the case of nurse communications, we connected the dots to the technologists’ response to the patient and how DR technology can facilitate that response.”
Fast-forwarding to 2015, Cretella broke out ways that radiology processes of care and efficiencies (such as maximizing patient participation and promoting radiation dose reduction) affect
- corresponding outcomes (such as reduced patient time in department and reduced patient dose),
- radiology measures (technologist responsiveness, dose management) and
- HCAHPS measures (responsiveness of hospital staff, communications about medicines).
In the radiology processes of care, positioning is a useful example, Cretella said. “The outcome is that the technologist can recognize patient acuity—what the patient is capable or incapable of doing to participate in the exam—because that’s what drives workflow,” he added. From that, there’s an efficiency gain with a more participative patient, leading to timely completion of exam.
“That connection over to radiology measures, which that could roll up to, would be responsiveness by the technologist,” said Cretella. “In an HCAHPS score, this may well improve staff responsiveness as an actual HCAHPS measure.”
Let the technology do the talking
Cretella next ran through a number of recent advances in DR room technology. Stressing that these can boost care measures under all four current VBP domains of care—process of care, efficiencies, outcomes and HCAHPS measures—he mentioned:
- Simple, close-at-hand controls that keep the technologist focused on the patient, not the equipment;
- Table/Bucky features that expedite positioning to minimize patient discomfort;
- Automation that facilitates exam reproducibility, expedited positioning and reduced staff repetitive stress injuries; and
- DR room architectures that expedite exam processes and minimize patient discomfort.
“And of course, as most vendors are offering today, simple unobtrusive designs of equipment, mood lighting and cheerful DR equipment—these details can help provide a positive exam environment and produce a calm, cooperative patient who can participate well in the exam,” said Cretella.
Turning to developments in DR image processing, Cretella ran through several ways that, over the past 32 years, diagnostic information has been elevated on the strength of advances such as dual-energy subtraction, digital tomosynthesis and, perhaps most dramatically, DR that potentially negates the need for an uncomfortable