February 28, 2019

Case Studies Bring ACR’s Imaging 3.0 Initiative to Life

American College of Radiology (ACR) Board of Chancellors Chair Geraldine McGinty, MD, FACR, knows it takes a good story to hold a radiologist’s attention—even when its message is relevant to his or her reputation and radiology’s prospects for survival.

Case studies have been a key feature of the Imaging 3.0 Initiative from almost the start of the program in 2012. The Imaging 3.0 initiative was established by then ACR Commission on Economics Chair Bibb Allen, Jr., MD, FACR, McGinty and other ACR leaders. The ambitious program pursued the dual objectives of changing attitudes that led Congress and the Centers for Medicare & Medicaid Services (CMS) to repeatedly cut medical imaging reimbursement rates and transforming a professional culture that encouraged the medical community to question the value of radiologists in clinical practice.

“Imaging 3.0 has really highlighted the value of imaging, and specifically the value of radiologists as the stewards of appropriate imaging,” said McGinty in an interview. “Imaging 3.0 and the individuals featured in our case studies have reshaped the culture of our specialty.”

In the same time frame, Congress responded with two key laws that advanced the transformative process. The Protecting Access to Medicare Act (PAMA) of 2014 mandated that CMS require ordering physicians to consult with appropriate use criteria (AUC), such as the ACR Appropriateness Criteria®, when ordering advanced imaging for Medicare beneficiaries. The Medicare Access and CHIP Reauthorization Act of 2015 instructed Medicare to transition from its traditional fee-for-service payment system to one that also rewards quality and clinical value.

Both laws led the ACR to continue to advocate for policies that emphasize imaging value over imaging volume. The creation of the Commission on Patient- and Family-Centered Care in 2015 helped increase radiologists’ visibility to their patients by creating toolkits to enable change. The College also secured a major grant from the Center for Medicare and Medicaid Innovation’s Transforming Clinical Practice Initiative. It funded the ACR’s Radiology Support, Communication and Alignment Network (R-SCANTM), a program that fosters partnerships between radiologists and ordering physicians to reduce imaging costs and increase clinical appropriateness.

Since 2013, the ACR has assembled a library of 108 Imaging 3.0 case studies, suggested and prepared by academic and community-based radiologists, to illustrate how the principles of Imaging 3.0 have been translated into real-life success stories. Two new case studies are added every month.

Of the current total, 31 relate to quality and safety. Thirty strive to increase patient engagement. Seventeen involve guidance for strategic planning. Twelve show how radiologists can use Imaging 3.0 to adopt and apply information technologies. Nine pertain to radiologists’ involvement in Medicare’s Quality Payment Program. Eight are dedicated to Imaging 3.0 applications for interventional radiologists and one involves a fictionalized story related to lung cancer screening and imagined scenarios that radiologists may encounter in the future.

“Eight Imaging 3.0 case studies currently cover R-SCAN and clinical decision support (CDS)/AUC implementation, and more Imaging 3.0 case studies involving AUC and CDS will be published as the January 1, 2020, implementation date for their mandatory use by Medicare approaches,” noted ACR Press Vice President Becky Haines. The ACR recently launched a CDS Data Registry, and new case studies will demonstrate the benefits of R-SCAN for collaborations investigating the appropriateness of advanced imaging.

“As a bonus, the Imaging 3.0 case study program has also created opportunities to showcase the work of young radiology leaders,” Haines noted. Syed F. Zaidi, MD and Ashima Lall, MD, MBA, both leaders of the PFCC Commission, are two such examples.

Sabiha Raoof, MD, radiology chair at Jamaica Hospital Medical Center and Flushing Hospital Medical Center in Queens, NY, followed a similar path to the PFCC Commission and then to an appointment with the national faculty of the Transforming Clinical Practice Initiative after publication of her Imaging 3.0 case study, When the Radiologist Become the Patient. It was inspired by her experiences as a breast cancer patient.

Samir B. Patel, MD, was appointed to the ACR Commission on Economics and has assumed leadership roles in his hospital after writing two compelling Imaging 3.0 case studies. In The Value of Hard Work, Patel, the director of value management at Radiology Inc., a group practice in Mishawaka, IN, created a “Radiology Value-Added Matrix,” that measured the numerous ways radiologists contribute to the performance of their departments and hospitals.

Patel’s colleague and program coordinator, Tricia Coatie, serves on the ACR’s Lung Cancer Screening 2.0 Steering Committee, which seeks broader adoption of screening by longtime smokers and other eligible populations.

In Patient Forward, Patel worked with cardiothoracic surgeons and other specialty physicians to open a Thoracic Oncology Clinic at Elkhart (IN) General Hospital. The program features low-dose CT lung cancer screening and brings together all the medical professionals involved in a patient’s lung cancer treatment for weekly conferences with their patients.

With Imaging 3.0 now in its seventh year, McGinty is beginning to realize the initiative is destined to lead to Imaging 4.0 and its likely integration with the ACR’s artificial intelligence tools and an expanded role in integrated diagnostics combining imaging, pathology and genomics data.

Case studies will continue to play a complementary role that’s worth advocating, she said. “They are a very powerful way to tell our story.”