What Admins Need to Know: A Recap of Hot Topics at AHRA 2014

Radiology administrators have a lot on their minds these days. New regulations—at both the state and federal level—must be accommodated, technology must be upgraded, and overshadowing it all is the new economics of healthcare that demands better care at lower costs. Fortunately, AHRA, the association for medical imaging management, offers some much needed guidance.

AHRA’s annual meeting always has great insights for radiology administrators. If you couldn’t be at this year’s conference in Washington, D.C., don’t worry; Health Imaging was on site. Read on for a recap of our coverage from some of the engaging presentations that caught our eye.

Caring about the patient experience

During one of the keynote presentations at AHRA, attendees were challenged to think beyond the satisfied patient. In the current healthcare environment, providers shouldn’t simply want satisfied patients, they should strive to create patient advocates.

Mark Mayfield, former corporate lobbyist turned performer and speaker, gave the energetic talk on the second full day of presentations, and tried to dispel some customer satisfaction myths that apply to medicine. One notion he urged the radiology administrators in the room to abandon is the idea that patients are either satisfied or unsatisfied. Providers should strive for a third category: the advocate.

“[Advocates] tell their story—your story—and the experience they had to other people, and they bring more people in,” he said.

A dissatisfied customer, on the other hand, may not tell the provider of their frustrations, but they do tell an average of 8-10 people, Mayfield added.

Another misconception in dealing with patients or, more broadly, the customer experience in general is that satisfaction is a static line. Mayfield said it’s more dynamic, and just because a patient is satisfied at one point doesn’t mean the situation won’t change quickly.

Mayfield also offered a twist on the golden rule, saying providers need to do unto patients as the patient would like done unto them. Providers can’t assume a patient would like information relayed in the same way the providers themselves do.

Ultimately, the No. 1 characteristic that will be judged is credibility, so Mayfield urged the audience to get off autopilot and don’t treat patients as a number. “I want you to care a little more than you have, because in the world of patient care, care is becoming more and more critical.”

Breast density notification: Soon to be a standard

Breast cancer screening presents a legal minefield for providers, and breast density notification laws are set to add another wrinkle to the already complex situation.

The U.S. is the most litigious country in the world, and breast cancer claims make up the greatest number of malpractice suits, according to presenter Bonnie Rush, RT, president of Breast Imaging Specialists in San Diego, Calif., and AHRA advocate liaison to Are You Dense Advocacy Inc.

One of the issues is a misconception among the public about what mammography screening can actually accomplish, Rush said. Many people feel that mammography screening is more definitive than it really is, and that radiologists should be held responsible in all cases where cancers are missed or there is a delay diagnosis.

Rush suggested that radiologists need to assume the role of educator, making sure to get the word out about the potential for false positives and false negatives to curb misconceptions. “We need to make sure that [patients] don’t end up…with an unreasonable expectation. They become disappointed, they then become angry, and then they litigate.”

As breast density notification legislation spreads through the states, the legal calculus will begin to change, added Rush. Judgment of negligence is based on whether a provider performed the standard of care, and with breast density notification laws now passed in 19 states containing more than half the U.S. population, it will soon be standard of care to notify women if they have dense breasts. Women with dense breasts who are not notified about supplemental screening options and then develop cancer will be able to point to the notification standard in other states and ask why she wasn’t informed.

About 40 percent of women have dense breasts, which both puts them at a higher risk of cancer and also obscures cancer on mammography.

Boost value with dose safety

Radiation dose safety presents an outstanding opportunity for radiologists to add value and assert their role in the care continuum, according to a pair of presentations at AHRA.

Chris Tomlinson, MBA, administrative director of radiology at the Children’s Hospital of Philadelphia (CHOP), described his organization’s experiences in creating a pediatric radiation safety initiative. One issue was the general public doesn’t quite understand the risk, but that doesn’t stop them from being concerned, as was evidenced by focus groups conducted by CHOP.

“What came back from the focus groups was ‘dose, dose, dose,’” said Tomlinson. “That’s what moms, dads, everyone was looking at.”

Shawn McKenzie, MPA, president and CEO of Ascendian Healthcare Consulting, who also spoke, added that the media doesn’t help and often sensationalizes the radiation risk of even a single CT scan.

A strong radiation dose safety program can provide better care for patients and, if marketed properly, can calm the fears of the public while serving as a differentiator for providers.

Tomlinson and McKenzie broke down the components of a radiation safety program, including:

  • Radiation safety committee – Team should include stakeholders from radiology, IT, risk management/legal, the C-suite level, and a medical physicist.
  • Optimized workflows – Providers must understand upstream workflows to a micro level, including all the providers involved.
  • Protocols – Multiple phantoms should be used to better reflect variation in patient size. There is a need to make sure protocols haven’t been modified erroneously, and automated software can help to manage protocols and provide surveillance.
  • Automated dose management solutions – Various software tools exist to help optimize workflow, provide dose data across the enterprise, and perform advanced phantom modeling.
  • Policies and procedures – Policies should be reviewed and updated by the committee annually, and have detailed risk management steps along with tactics for communicating with patients.
  • Risk management and legal – A provider’s risk management and legal team needs to be involved to share their concerns, and it won’t always be about dose itself. With radiation getting such a high profile in the media, some worry that scans won’t be ordered out of dose fears. “It can’t get in the way of medicine, bottom line,” said McKenzie.
  • Outreach – In addition to educating patients, radiologists can reach out to referring physicians to make sure they are up to date on the latest technology and guidelines. This outreach can even extend to other providers in the community, said Tomlinson. “When we do see [pediatric studies] being done at greater than the ACR [dose] limits for adults, that becomes a concern. We’re not in the business of telling other hospitals what to do, but we do spend time calling those hospitals and offering our services.”

McKenzie was joined by Neomi Mullens, project manager for Ascendian Healthcare Consulting, for a second presentation, which included a look at radiation dose legislation at the state level. Current state laws vary slightly, and build on what came before.

California’s law, which took effect in July 2012, focused on CT dose management, incident reporting and dictating dose values in the final report. However, the law had gaps and lacked clear definitions, according to Mullens. Texas then refined the ideas in the California law and added fluoroscopy and radiation safety committees to the mix.

A similar law is awaiting hearing in the Connecticut house, and policymakers in all states are looking at the initial regulations from California and Texas, according to McKenzie and Mullens.

Avoiding a design trap

When tackling a big facility design project, it’s tempting to just hire an architect and let the experts handle it. However, this can lead to issues where a project plan doesn’t meet the specific needs of the practice. And when it comes to facility design, these issues mean big bucks.

To avoid this, administrators should not lose control of a radiology facility design project by delegating it to others who either don’t have the expertise or don’t have the provider’s interest in mind.

There are a number of facility design factors that can impact image quality, explained Robert Junk, AIA, president of RAD-Planning in Kansas City, Mo. Vibration from nearby machinery or even building sway can reduce quality, as can electromagnetic and radio frequency interference from power lines and cell towers. There are also specific considerations for structural capacity, construction materials and heating/air conditioning.

“I’m not saying that you all need to be the experts in this, but you need to make sure who’s doing it for you understands these things,” said Junk, adding that at the end of the day, those designers will leave, but any problems will remain for the provider to deal with. This is why it’s important to work with architects who specialize specifically in radiology facility design, not just medical facility design.

Likewise, administrators can’t always trust the vendor to include every requirement in its product specifications, as they are ultimately interested in selling equipment. Junk said facility requirements supplied by vendors only account for about half of the needed elements, leaving out necessities such as changing rooms and staff areas.

A facility should be planned with the idea that no piece of equipment lasts forever, so construction should never simply settle for the minimum requirements. If a vendor specifies a ceiling height requirement, for example, that will be precisely what is needed down to the inch, and if the ceiling is built right to that level, it may prevent the provider from being able to switch to a different vendor’s equipment in the future.

Providers will spend hundreds of thousands of dollars on a facility, but millions on scanners. Junk noted that administrators should understand that construction costs don’t measure up to equipment costs and plan accordingly.  “You want to make sure the room is designed to take that piece of equipment and take care of it.”