The efficiency crisis: No quick fix

Radiologists trapped in the endless cycle of efficiency gains may find a bit of solace in the masters of radiology panel discussion, published in the October issue of the American Journal of Roentgenology, which tackled the question: Hyperefficient Radiology—Can We Maintain the Pace.

Answers included redefining relative value units (RVUs), redistributing workflow and upping vendor feedback.

Norman J. Beauchamp, Jr., MD, MHS, from the department of radiology at University of Washington in Seattle, contrasted hyperefficiency with hyperbusiness. He explained that maximum efficiency is attained by the elimination of unnecessary effort or steps. “I do not believe most of us are hyperefficient. We are, however, unequivocally hyperbusy.”

Beauchamp proposed that elimination of inappropriate imaging studies, approximately 25 percent of all exams, could help address the issue. However, this solution, like others, requires an upfront investment of work. He also noted that radiologists can play a key role in implementation of the American Board of Internal Medicine's Choosing Wisely campaign with respect to decreased imaging utilization.

Several panelists noted that different physicians work at different paces in any department. The result is dramatically different RVUs.

Marcia C. Javitt, MD, from the department of radiology at Uniformed Services University of the Health Sciences in Bethesda, Md., offered the concept of the team RVU. “Team RVUs have a value system in which groups work to provide value to the patients, physicians, and practitioners. Such a system goes beyond traditional RVU metrics to include administration, leadership, service to our departments and institutions, professionalism and attention to quality and safety.”

Similarly, Beauchamp advocated for a redefinition of value, citing a recent partnership with OB-GYNs on a community-based fetal ultrasound program. “Did they want to partner with us solely based on our image interpretation skills? Nope. They also have great respect for our ability to effectively reach across distance and organizations to acquire, interpret and report ultrasound examinations.”

Alexander M. Norbash, MD, from the department of radiology at Boston University Medical Center, recommended departments consider macro and micro level workflow adjustments. At the macro level, radiologists might be re-distributed to improve efficiency. At the micro level, individual ergonomics might be assessed and revised to accelerate efficiency.

Norbash also called on radiologists to push and prod vendors on workflow processes and systems integration. “These complex systems [PACS and RIS] do not work as well as they really should to help us be efficient. They are far from plug and play.”  

He also referred to undercultivated industrial partnerships as a potential source of efficiency gains. Unlike test pilots who fly and refine airplanes during the development stage, radiologists are notoriously quiet in the systems design process. “We sit and receive from the vendors what they think we want because they solicit feedback from small panels of familiar physician experts who may not necessarily have broad insight regarding the larger market and the horizontal needs of most pilots.”

Despite the challenges, at least some of the experts remained optimistic. For example, Norbash stated, “Evolution happens when there are stressors.”