Physician time savings could emerge as reimbursement metric

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To prepare for a transition from fee-for-service payments to value-based reimbursement, radiologists must better demonstrate their value, which can be accomplished by focusing on time as a value measure, according to an article published in the October issue of the Journal of the American College of Radiology.

Radiologists should emphasize the time saved by imaging, especially the downstream costs of physician time, according to authors Christoph I. Lee, MD, of the Robert Wood Johnson Clinical Scholars Program at University of California, Los Angeles (UCLA), and Dieter R. Enzmann, MD, of the David Geffen School of Medicine at UCLA. The specialty also needs to focus on its most important product, actionable information, as opposed to focusing on imaging technology, added the authors.

“Given the increasing risk for marginalization, radiologists need to engage clinicians and managers to map the processes and associated costs of episodes of patient care to identify areas for providing and improving integrated diagnostic information and to measure the value thereof,” wrote Lee and Enzmann.

Radiology has failed to demonstrate its value on patient outcomes. Quality measures are typically process measures, and don’t necessarily capture value, explained the authors. Moreover, the Resource-Based Relative Value Scale (RBRVS) system currently in use is focused on reimbursements and has led to excess utilization of more highly reimbursed services.

“Although the main driver of this distortion did not arise directly from within radiology, the consequence has been to constrain radiology with a simplified ‘turning down the spigot’ approach to control increasing costs via the Deficit Reduction Act of 2005,” wrote the authors. “Simply lowering the reimbursement for imaging services has, however, done little to actually control overall costs.”

A radiologist’s value can be captured as the product of the time required for a service and intensity of work per unit of time, according to Lee and Enzmann. Overall costs include physician time, and using time efficiently can decrease aggregate healthcare costs.

“In this system, value is measured in terms of patients outcomes achieved per dollar expended,” wrote the authors. “The relevant cost is the total cost of all resources expended, including the time of clinical and administrative personnel, supplies, devices, office space, and equipment.”

This focus on time extends beyond the radiologist and includes the full series of events patients experience during episodes of care. “Investing in a radiologist's time, a technologist's time, the use of scanner time, and other imaging-related direct and indirect imaging costs up front may be less costly than downstream expenditure of the surgeon's time, intensivist's time, operating room time, ancillary staff time, surgical equipment, longer hospital admission stay, and so on.”

And since imaging information lives in a PACS for long periods of time, it becomes “mineable data” which can be consulted at a later date, post-processed for quantitative data and otherwise offer continuous value, explained the authors.

It is because of this persistent value that Lee and Enzmann argue that the process of service valuation in new models of healthcare delivery should occur at two levels: determining value of diagnostic information as it is currently used and determining value based on potential reuse at a single initial cost.

“These multidisciplinary accounting exercises will aid radiology in moving from a mindset of simply interpreting images to creating and organizing information for improved accuracy and lower cost in medical decision making in an integrated environment.”