Quality metrics could help stem the commoditization of medical imaging

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The threat of radiology becoming a commodity has increased in part due to teleradiology, accelerated information exchange and the development of new technology, according to a perspective in the March issue of the J ournal of the American College of Radiology. To prevent this trend, medical imaging practitioners need to develop objective and reproducible quality-oriented metrics that can be used to differentiate service deliverables on the basis of quality.

Products or services become commoditized when there is no differentiation between how they are perceived and price becomes the determining factor in provider selection.

"The current focus on the economic bottom line in healthcare creates the potential for radiology to become a commodity, devoid of qualitative differentiation. This trend toward commoditization has been accelerated by the globalization of imaging services (teleradiology), increased information exchange (e.g. digital imaging and communications in medicine, integrating the healthcare enterprise), and new technology development (e.g., PACS, computer-aided detection (CAD)," wrote the authors Bruce I. Reiner, MD, and Eliot L. Siegel, MD, from the University of Maryland School of Medicine.

To avoid commoditization, imaging services must be differentiated on the basis of qualitative measures--those that are reproducible and objective. Existing initiatives are in place; however, the authors offer several recommendations for expansion, as well as opportunities to tie them to economic incentives, such as pay for performance.

"The optimum strategy for avoiding commoditization is the creation of objective quality metrics and standards throughout the medical imaging practice, which will provide a reproducible and objective means with which to differentiate imaging service deliverables on the basis of quality and clinical outcomes. These quality measures can in turn be directly tied to economic incentives (pay for performance), providing further incentive for proactive quality assurance, qualitative differentiation, and technology development centered on quality," Reiner and Siegel wrote.

The authors' recommendations included:

  • The acceleration of pay-for-performance economic incentives by third-party payors to promote proactive quality assurance in everyday medical imaging practice;
  • The development of clinician, radiologist, and technologist review processes and computer-aided analytic algorithms to improve the consistency of assessment of image quality, diagnostic accuracy and exam appropriateness, using an informatics-based approach;
  • The creation of a standard for reporting these objective quality assessment measurements and a means for reporting them combining data from multiple disparate information systems within an imaging department and hospital enterprise that would allow benchmarking of quality information for imaging practices; and
  • The creation of a "culture" that encourages quality assessment and improvement in a positive and constructive manner, as has been suggested for hospital medical error reporting.