Leverage data to reduce risk, predict trends, reduce costs and improve patient outcomes
In today’s healthcare landscape, radiology groups face a daunting challenge: improve the value of patient care while increasing their bottom line and enhancing productivity.
Other industry changes, including evolving reimbursement models, better informed healthcare consumers and rising costs, complicate things even further. This fragmented landscape demands better communication between providers, patients, payers and communities throughout the U.S. healthcare system.
A solution that is gaining more traction throughout the industry is the use of advanced analytics platforms, which can integrate, organize and analyze data to better understand how organizations are performing, what clinical results need improvement and whether patient needs are being met. Analytics can provide radiologists a more concise view of the information contained within the massive volumes of data available to them and their practices, empowering their clinical decisions.
By integrating an advanced analytics package that can handle both structured and unstructured data, radiology leaders can delineate the information within these data sets to improve practice performance and increase the quality of care they provide to their communities, facilities and patients they serve.
Mitigate Risk
Radiology groups are consolidating rapidly; one of the outcomes of this rapid consolidation is the attainment of the economies of scale necessary to decrease their malpractice insurance costs. While many groups may not be taking full advantage of the many additional opportunities for collaboration and cost-savings brought through the use of advanced analytics, those that are, are reaping positive financial benefits through decreases in malpractice expense as well as decreases in other benefits costs, management expenses and even supply acquisition and equipment maintenance costs when applicable.
Applying analytics to the cost of malpractice coverage allows radiologists and insurance carriers to team in their efforts to track specific metrics and construct a superior medical risk avoidance program based on documented, detailed outcomes of the group’s performance. The malpractice carrier and the radiologists can define and develop specific metrics that can significantly impact the pricing of the program, then document the trending of these metrics over time which can reduce malpractice costs for radiology groups.
Improve Patient Outcomes
Unless unstructured data is integrated, radiology practices are limited in their abilities to influence and manage the practice care continuum outcomes.
Radiologists team with all other medical specialists to control dosages, develop diagnostic next steps and provide their specialty specific insights into patient conditions, which will assuredly have an impact on patient outcomes. In this case, monitoring and tracking interpretive accuracy by provider, allergic contrast reactions and complications (e.g. extravasation of contrast media injection), and pediatric dosing complications could play a major role in demonstrating the value brought by radiology.
With this data, radiologists would be able to develop and implement policies and/or protocols regarding patient selection criteria and imaging that would improve outcomes, thus quality, in patient care.
Enhance Productivity
Through the integration of both structured and unstructured data, radiologists may be better positioned to target patient-specific interventions, tweak treatment regimens, prevent readmission or adverse events, and identify worsening conditions earlier. The development of personalized medicine and genomic mapping can play a major role in the application of therapeutics within the course of patient care, and it is through the delineation of many of these personal medicine factors through medical imaging that the specific therapeutic can be identified and applied.
Measurement of data points to enhance physician productivity are also important — some to consider are inclusion exam call-backs and exam image quality. The appropriate identification of possible data points and then the extraction of the information within those data points is paramount to the building/demonstration of the value radiology can bring to patient care and the patient care continuum.
Access and utilization data sets — structured and unstructured — can be utilized to improve overall process efficiency, increasing the efficacy of the delivery of the technical and professional components of medical imaging care. Prioritization of service delivery based upon patient need, optimization of study sequencing and even stabilizing volumes to allow for a uniform workflow from both the technical and professional component perspective, would also be possible through the appropriate application of structured and unstructured data analysis.
Exceed Quality Standards
As the government increasingly focuses on accountability and heightened regulatory control, it is critical for provider groups today to demonstrate their value. By wielding structured and unstructured data, physician leaders can now demonstrate value by achieving better outcomes, reducing waste and improving patient satisfaction – basically meeting the yet to be fully defined components of the Clinical Practice Improvement segment of the Merit-based Incentive Payment System (MIPS).
A crucial step in this process is comparing a group’s data sets and metrics to comparable industry data from the government, comparable practices and professional organizations such as the American College of Radiology, which supports the National Radiology Data Registry.
Key metrics which might be compared could include report turnaround time, turnaround time for correcting discrepancies, critical results notification times, radiation dose or even study “reassignment” for appropriateness via a clinical decision support type approach. Any and all of these metrics could be tracked, trended and utilized to demonstrate overall improvement and thus reported as a clinical process improvement.
Prepare for Alternative Payment Models
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the Sustainable Growth Rate (SGR) model for Medicare physician payment with a framework for the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
According to the Centers for Medicare and Medicaid Services (CMS), providers who receive professional fees under Medicare Part B must participate in either the MIPS or APM payment models, with all providers reporting value-based metrics. Participants in MIPS will receive a Composite Performance Score (CPS) based on quality, resource use, clinical practice improvement and advanced care information. APM participating practices will need to meet specific goals of at-risk contracting to meet the APM participation criteria.
While CMS has yet to fully and clearly delineate what data points will be necessary to successfully participate in these evolving payment models, we do know that practices will need to assess risk and cost associated with supporting certain procedures. By using a powerful analytics platform, practices can leverage data to analyze medical history and records for multiple patients, assess cases relevant to that episode of care and outline the protocols that were in place. This information could also be utilized to identify typical costs and appropriate reimbursements within the associated episode of care/bundled payment model reimbursement scheme.
Analytics and data sets have become powerful tools in today’s healthcare industry. By leveraging data, and the information contained within that data, radiologists can derive new intelligence to help reduce risk, predict trends, reduce costs of care and improve patient outcomes.
As U.S. healthcare spend continues to skyrocket, it is more critical than ever for radiologists to be informed and prepared to improve outcomes while lowering costs. But they are not expected to do it alone; in this dramatically changing landscape, the once-clear lines between medical device and drug companies, payers who provide financial support, patient-consumers who receive treatment, and providers who diagnose and perform procedures are more blurred than ever.
The radiology industry is now turning to more collaborative forms of care, supported by robust analytics capabilities, among all key players in the industry.
This column was made possible by a partnership between ADVANCE and RBMA. For more information on RBMA, call 888.224.7262 or visit www.RBMA.org.
