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.
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.
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 (to the patient) and often unwieldy (to the technologist) anti-scatter grid on top of the detector.
“DR image processing is changing the fundamentals of radiography,” he said, adding that the latest DR detectors are highly durable, resistant to liquids and capable of being coated with anti-bacterial treatments that help ward off the spread of hospital-acquired infections. All of these advances, and others, have obvious positive implications for HCAHPS scores, he pointed out.
Last but far from least in this portion of the presentation, Cretella spotlighted ways that DR technologies can support standard measures and protocols to facilitate a hospital’s initiatives around reducing radiation doses in imaging. Here the carryovers to the radiology domains of care include ALARA image acquisition for exposure surveillance (process of care domain), improved image acquisition with low remnant x-rays for appropriate dose delivery (efficiencies), reduced patient dose for ALARA dose management (outcomes) and communication about medication for that very HCAHPS measure.
“Dose efficient technology is for everyone,” said Cretella, stressing the degree to which the technology has enabled the reduction of patient dose without sacrificing image quality.
“The goal of the radiology department is to manage their processes to provide excellence in patient care, using the domains of care,” added Nicholas. “It was important that we develop these concepts so that a radiology department can effectively market their particular services.”
Welcome to the age of ‘pull’ marketing
To that end, Nicholas noted four marketing challenges radiology departments need to deal with—commoditization of services, dependency on referring physicians, “lack of value” patient perceptions and getting the right message out.
On the latter challenge, he said, most hospitals today miss a golden opportunity by emphasizing a “push” marketing strategy aimed at referring physicians over a “pull” strategy that would directly appeal to patients. He gave as an example a highway billboard in which a hospital shows the JCAHO award symbol under the headline “One of the area’s ‘Top Performers.’”
“For the most part, most consumers of healthcare services are not aware of what the Joint Commission is,” he said. “Therefore, the effectiveness of this billboard is largely lost on the potential patient.”
Taking the discussion back to HCAHPS and the domains of care, Nicholas explained that people tend to use a series of mental shortcuts, or heuristics, to make their decision-making process easier.
“These can be rules of thumb, best guess or gut feeling,” he said. “Another way patients decide where they go to seek out healthcare treatment is considering anecdotal experiences from friends and relatives who may have been through something similar. This vividness of experience is probably more influential than the data the HCAHPS scores represent.”
Then too, consumers tend to find the HCAHPS data hard to find and difficult to apply. It’s better to incorporate semantic influences in marketing messaging, said Nicholas, such that consumers “begin to recognize that you are talking directly to them.”
It is with this in mind that hospitals and radiology departments can develop a more customer-centric, or pull, marketing strategy, Nicholas said.
“Focus more on responding to what we think patient’s needs might be, using all the metrics you can develop, tabulate and capture through the processes, outcomes and efficiencies domains of care,” he said. “Use that information to convey to the patient that you are in tune with their particular needs and that your facility is the place to come when they need to have their healthcare needs addressed.”
As an example of what can be done from this starting point, Nicholas showed an example of a display ad that one radiology department created after acquiring new DR technology.
Under the headline “Celebrating less,” accompanied by a photo of a child smiling her way through a confetti storm, the department announced its acquisition of Fuji’s D-EVO system. “Less radiation—30 percent to 50 percent less than conventional x-ray,” the body copy reads. “Less image acquisition time. Less image processing time. Superior quality images.”
“This department seized the opportunity,” Cretella said. “They truly made it a marketing opportunity by putting these posters up in the x-ray waiting room and throughout the radiology department. Be it a subliminal message or not, when the patient waiting for an x-ray exam reads this poster, he or she recognizes maybe for the first time that less dose is better. This may correlate to the attracting of more patients and an improved ‘communication about medications’ score for HCAHPS.”
“Metrics brought about by value-based purchasing can be used as effective marketing tools for any radiology department,” concluded Nicholas. “If used properly, this information can be a very effective differentiator when you compare your hospital to the hospital down the street. Those metrics will become the key marketing information that can help you do a more effective job of marketing your services and expanding your customer base.”