Focusing on outcomes and the value of service provided

Article of Interest

 

Source:  Radiology Business

Article Date :  10/13/2015

Author : Julie Ritzer Ross 

The Data-driven Practice: How Quality Metrics and Data Are Driving Radiology

Turnaround time, step aside: A new generation of quality metrics is paving the way toward value-based radiology 

Healthcare reform continues to impact nearly every—if not all—aspect of radiology practice. One of the most significant changes is a transition from a volume-based, fee-for-service model contingent on RVU production to one that is based on the delivery of value-added, quality care. Such factors are indeed leading to the formation of intricate, wide-reaching quality agendas and infrastructures under whose terms myriad quality measures are tracked and quality targets are carefully chosen and prioritized, with data used to assess progress.  

“There’s no getting around the need for quality infrastructure and metrics to prove value,” says Steven Miles, MD, FACR, president and chief quality officer of Halifax Health, Daytona Beach, Fla., which provides a continuum of healthcare services through a network that encompasses two hospitals, four cancer treatment centers, the area’s largest hospice organization, psychiatric services and a preferred provider organization. Halifax Health also is one of six independent radiology practices that make up the core of Preferred Radiology Alliance (PRA), Daytona Beach, Fla., a managed services organization (MSO) that spans 124 physicians, 21 hospitals and 15 outpatient imaging centers.  

In the new healthcare paradigm, Miles asserts, “nobody is going to be paying per click. Data that illustrate value are going to be just as important as the bill.”

Lasting, cultural change

For Radiology Associates of Canton (RAC), Canton, Ohio, the shift Miles describes has occurred under a co-management agreement for the radiology service line. Forged four years ago with Canton-based Aultman Hospital, to which RAC has long provided subspecialized imaging services and 24/7 on-site night coverage, the agreement calls for a governance model wherein all departmental decisions are made jointly by RAC’s radiologists and the hospital administration, and for the approval of capital purchases by both entities. More importantly, it mandates a quality infrastructure wherein clinicians are paid on a performance basis and a patient-centered radiology program that harnesses radiology clinical coordinators to expedite care and decrease length of stay (LOS) for certain patients.

“The co-management agreement came about largely because of pressures brought on by the volume-driven marketplace,” states RAC President Syed Zaidi, MD. Zaidi, who also serves as CEO of a consulting and management entity that assists hospitals and other radiology practices in developing similar partnerships, notes that before the agreement was solidified, RAC was grappling with unrelenting reimbursement cuts, internal disagreements about focusing on increasing volume as opposed to offering consultative services to its clinician and wavering hospital relationships despite a high level of volume-driven service. A consulting firm had been brought in by the hospital to evaluate whether RAC—whose contract was up for renewal the following year—could be displaced in favor of improved radiologic services.

“We proposed co-management, and the hospital administration bought into it because they liked the philosophy behind it, which is to create a framework that supports lasting cultural change adopted by both clinicians and administrators,” Zaidi notes. “Aligned incentives connected to quality and efficiency improvement initiatives drive that change.”

Within the new quality- and value-oriented model stipulated in the agreement, pay-for-performance is based on metrics to which fair-market value is tied and that were chosen with the intent to measure individual and collective progress, trends and RAC radiologist effectiveness. “Some of the metrics—like inpatient and emergency department turnaround time—are convenient and easily measurable,” Zaidi says

 RAC was fortunate in that a precedent for co-management had already been set at Aultman with the deployment of such a model for employed cardiologists and independent oncologists. “However, we go beyond that because the whole purpose here is to measure meaningful data and build a better platform for improving the caliber of imaging services and [foster] engagement with referring physicians,” he notes.

 

January 26, the Department of Health and Human Services (HHS) made a historic announcement. The Medicare program, which in 2012 provided insurance for more than 49 million older Americans, has historically functioned as a fee-for-service (FFS) payor, reimbursing providers for the volume of services they render. In 2014, Medicare made US$362 billion in fee-for-service payments. But as part of an effort to bring government spending on healthcare under control, Medicare is moving to a new paradigm—focusing on outcomes and the value of service provided, rather than volume. Instead of simply reimbursing providers according to set formulas, the agency has been experimenting with alternative payment models, such as accountable care organizations, bundled payment arrangements, and medical homes.

HHS announced that Medicare will boost the percentage of its payments devoted to alternative payment models from 20 percent in 2014 to 30 percent in 2016 and to 50 percent in 2018.

The announcement also calls for the proportion of all FFS payments to be tied to quality or value in general to rise to 85 percent in 2016, and to 90 percent in 2018. In addition, HHS aims to develop and test new payment models for specialty care and expand the alternate payment mechanisms well beyond Medicare by working closely with different key stakeholders, including state-run Medicaid programs, private insurers, employers, patients, and the broader provider community. HHS also indicated that it will invest $800 million through 2018 to support nearly 150,000 physicians participating in the programs with tools and skills to enable this transformation.

Understanding  and preparing for the various payment models require time and preparation, our Healthcare Consultants are prepared to assist providers to understand the concept and meet the required goals and/or outcomes.

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