The American College of Radiology (ACR) capitalized on a welcomed invitation from the Centers for Medicare & Medicaid Services (CMS) to report to the 2019 CMS Quality Conference in Baltimore January 29–31 on how clinical professional associations and individual radiology group practices are accelerating the national movement toward value-based care.
As one of only two Support and Alignment Networks (SANs) invited to bring a practice representative to speak, the ACR focused on its Radiology Support, Communications and Alignment Network (R-SCAN) as a change agent.
R-SCAN Program Director Nancy Fredericks described the program’s efforts to promote the ordering of imaging exams based on evidence-based guidelines to ensure patients receive imaging tests that add value of their care, avoid inappropriate imaging and lower costs. She listed how R-SCAN is assisting medical imaging’s transformation through the following tenants of the CMS Transforming Clinical Practice Initiative:
- Coordinated care delivery to ensure quality referrals
- Evidence-based care to reduce unnecessary tests
- Population management to develop data registries
- Quality improvement strategies that support a culture of quality and safety
- Optimal use of health IT as an application of technology to support evidence, and
- Strategic use of practice revenue with payments that reward superior performance.
“As of September 2018, R-SCAN supported 158 registered projects, implemented by 120 imaging practices and involving 10,000 clinicians,” Fredericks said.
As a R-SCAN participant since 2017, Radiology Partners (RadPartners), with its 1,200 radiologists practicing at 856 sites in 18 states, was presented at the CMS conference as an exemplar of how a group practice can use R-SCAN to ensure its members apply best practices.
Syed F. Zaidi, MD, vice president of clinical operations and growth at Radiology Partners, at the
2019 CMS Quality Conference. Dr. Zaidi described how R-SCAN has helped his group to apply best
Syed F. Zaidi, MD, RadPartners’ vice-president of clinical operations and growth, explained during a January 30 presentation that the group joined R-SCAN to demonstrate their efforts in adhering to best practice recommendations based on its own experiences with the Choosing Wisely® program combined with experiences shared by other R-SCAN participants.
In particular, RadPartners focused on R-SCAN techniques to increase its radiologists’ compliance with a Choosing Wisely recommendation against the use of follow-up ultrasound for examining incidental thyroid nodules (ITN) in low-risk patients. The initiative helped increase compliance with the recommendation to more than 90 percent.
“This use of best practices has shown to our stakeholders including health systems and payers that we can raise the bar of quality and help our referring physicians select appropriate management and treatments,” Zaidi said.
The high compliance rate was attained after about two years of effort, beginning with first developing the best possible practice recommendations based on a thorough examination of the medical literature and internal radiologist engagement. RadPartners then applied data mining techniques to calculate its radiologists’ behavior, focused education and ongoing monitoring, with monthly “report cards” to provide periodic feedback to individual radiologists and groups, and oversight by RadPartners’ practice council, which continually fine-tunes the initiative.
Efforts that extended RadPartners’ group practice culture to its referring physicians were particularly important. “We are guiding our referring physicians with our recommendations to the point where we’ll mention when follow-up is not needed. We discourage inappropriate follow-up,” Zaidi said.
With its large size and broad geographic reach, RadPartners’ President and Chief Medical Officer Jay Bronner, MD, MBA, envisions the practice continuing to serve as a clinical laboratory to establish best practices for more imaging applications and leverage our diverse database and infrastructure to prove their effectiveness.
“Radiology Partner’s focus on improving clinical value is very much aligned with the ACR and we are demonstrating that radiologists can play a key role in contributing to effective patient management. We see additional opportunities for collaboration, such as providing input on the development of organ system-based white papers and effective programs that ensure that our recommendations are followed up in an appropriate timeframe. These types of programs can help to save lives, which at the end of the day is why we all went into health care as a profession.”
The value created by the ITN and other R-SCAN initiatives has led to significant benefits recognized by payers from their execution. RadPartners has negotiated value-based contracts with one major insurer in several states where its radiologists practice. Compliance rates reported on its monthly scorecard are shared with local physician boards and some physician boards have chosen to incorporate adherence to best practices in physician evaluations.
“By participating in R-SCAN and working with our academic partners, we’ve learned it’s worthwhile to invest in best practices,” Bronner said. “It’s worthwhile to engage in a culture of change that positively affects the behavior of its radiologists and their referring physicians. And it’s worth the effort to invest in the necessary technology and infrastructure to add value to your services for providers and patients.”