RSNA: Can imaging gatekeeping thwart commoditization?

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CHICAGO—One emerging practice management theme encourages radiologists to consider a more active role as gatekeepers of imaging. Alan D. Kaye, MD, CEO of Advanced Radiology Consultants (ARC) in Bridgeport, Conn., shared how the practice has successfully implemented the gatekeeper role during a presentation Nov. 28 at the annual meeting of the Radiological Society of North America (RSNA).

The session asked the controversial question: should radiologists take a more active role as gatekeepers? According to Kaye, the answer is yes. The approach helps radiology practices move into leadership roles. It also can boost the bottom line and enhance patient care and quality.

Kaye first defined the gatekeeper role, explaining its two functions—keeping out the undesired elements and letting in the desired elements. Undesired elements such as unnecessary exams and unnecessary costs can be contained via tools such as imaging guidelines, appropriateness criteria and point-of-care decision support, said Kaye.

On the other hand, gatekeeping involves performing the right exam on the right patient correctly the first time. Screening exams can fit into the gatekeeping model by improving outcomes and quality and saving money, said Kaye.

IT can be leveraged to achieve these goals. Kaye offered the example of ARC’s Screening Mammography Dropout Project, an internal pilot project to mine its RIS and patient portal to enhance compliance with guidelines for screening mammography, to illustrate the point.

The project illustrates how Meaningful Use (MU) requirements may benefit radiology. MU facilitates patient engagement through a mandated patient portal, noted Kaye. Screening mammography is a universally accepted metric for quality of care.  

ARC mined RIS data for women ages 40 to 75 years old eligible for screening mammography who had undergone other imaging tests with ARC but never had a screening mammogram. Emails were sent to 976 such patients who established patient portals with ARC and letters to those who had not.  Of these, 235 patients responded by scheduling a screening mammogram.

Such gatekeeping projects can enhance radiology’s leadership in the healthcare community, improve quality and engage patients. “We can change from commodity to clinician,” concluded Kaye.