Before the onset of COVID-19, American families reported that paying for healthcare was their greatest financial concern. With the United States facing an unprecedented health crisis and a lengthy economic recession, reducing healthcare costs and eliminating health disparities has never been more urgent.

The ACR has been tackling these challenges for decades, as demonstrated by the ACR Appropriateness Criteria®, the College’s participation in the Choosing Wisely® campaign and the RSCAN® initiative. Refining care delivery systems and demonstrating how imaging can improve patient outcomes is the next hurdle in transforming healthcare. The JACR® will be devoting its September 2021 issue to the topic of care transformation. This focus issue (proposals are due Sept. 1) aims to disseminate provider-led initiatives championed by radiologists and non-radiology specialists that increase the efficacy and efficiency of care delivery.

The Bulletin recently spoke with Pamela T. Johnson, MD, FACR, vice president of care transformation for the Johns Hopkins Health System and professor in the Johns Hopkins Medicine department of radiology, and Yoshimi Anzai, MD, MPH, associate chief medical quality officer and professor of radiology at University of Utah Health Sciences, who will be serving as co-editors of the special issue, to discuss their work in the care transformation movement and the types of research submissions they’re looking for.

What does care transformation look like in radiology?

PJ: Reducing unnecessary imaging was the first frontier, and a lot of work has been done to increase imaging appropriateness within radiology and from other specialties. Now we’ve moved on to harness imaging to reduce more costly elements of care, like ED visits and hospitalizations. Imaging can function as a triage tool in the outpatient setting, by determining if a patient with abdominal pain needs to go to the ED and in the ED, by identifying patients with noncardiac chest pain who can safely be discharged home . 

YA: Radiologists can play a more active role in a patient’s care management. We need to go beyond just the closed-door reading room and become a part of the care team. We are the best source to explain how imaging could help medical decision-making by the provider and benefit the patient.

How can radiologists get involved in the care transformation movement?

PJ: It begins with building a multispecialty team — it can’t just be the radiologist in their institution. Radiologists need to collaborate with the hospital care team, ED providers and ambulatory practices by using health system data to identify where imaging is overused and underused. Radiologists can forge these relationships in their work to meet the requirements of CMS’ Appropriate Use Criteria program. Every institution is required to have a clinical decision support mechanism that ambulatory and ED providers must consult when ordering advanced imaging.  

YA: Joining the High Value Practice Academic Alliance is a great place to start. We have faculty leaders from 100 academic centers in more than 30 specialties. We collaborate on consensus recommendations to follow incidental findings and developing standardized interpretations, and collect the data to create high-level evidence from multiple institutions.

COVID-19 is forcing us to be more focused on appropriate imaging, testing, and surgery.

What can people expect from the JACR care transformation special issue?

PJ: We’d like to spotlight innovations that show the value of radiology to increase efficiency and effectiveness of care. We really want data on how an intervention was done and how outcomes were improved. Care transformation isn’t just about reducing cost, but about making improvements in patient care delivery, effectiveness, and efficiency — with quality and safety as a priority. 

YA: COVID-19 is forcing us to be more focused on appropriate imaging, testing, and surgery. For the past 10 years, radiologists have been focused on reducing imaging because of cost, and we have to think about the underutilization of some imaging that is perhaps beneficial. We’d like to see submissions of how imaging impacts the treatment pathway.