The importance of demonstrating and expanding value as radiologists was the central theme of the ACR Annual Conference on Quality and Safety, held in Boston Oct. 13–14, 2017. Jonathan B. Kruskal, MD, PhD, FACR, chair of the department of radiology at Beth Israel Deaconess Medical Center and chair of the Commission on Quality and Safety’s Quality Management Committee, opened the conference by discussing the present state of radiology. “We currently exist in a disconnected state,” he said. “We are a small cog in the wheel of value-based health care, and we cannot afford to overestimate our contributions nor how others perceive our value proposition.”
Despite early adopters and initiatives emphasizing the improvement and recognition of radiology’s value, including Bibb Allen Jr., MD, FACR, who founded the ACR Imaging 3.0 program, many have not embraced cultivating radiology’s value, according to Kruskal. Why? Given the current political climate, many are justifiably uncertain about the future of the Affordable Care Act and how it will impact health care, reimbursement and the fee-for-service paradigm. Another perhaps less complicated reason is that many don’t know how to define value and are unsure how value truly impacts their organization’s outcomes.
The peer learning process is one of the primary ways to improve radiology’s value to referring physicians as well as patients. During a session dedicated to the topic, several physicians presented their success stories in implementing overhauls to the standard peer review process at their organizations. For example, Richard E. Sharpe Jr. MD, MBA, the value adviser for the Department of Medical Imaging at Kaiser Permanente Colorado, described how he leveraged existing resources within his department to improve overall performance. He highlighted two ways to learn from clinical practice:
Sharpe’s changes began incrementally. He began attending closed-door peer review sessions and made suggestions on how to improve the process. When placed in charge of peer review five months later, he began to make significant changes. He sent out a survey and made radical changes based on the results, including incorporating CME accreditation for peer learning conferences and inclusion of an online module. The name “peer review” was also changed to “peer learning” to better reflect the inclusive nature of the improved program.In his presentation, titled “Consensus Group Peer Learning: The MGH Experience,” H. Benjamin Harvey, MD, described changes to his department’s peer learning program at Massachusetts General Hospital (MGH), in which his team designed departmental teaching conferences involving groups of staff radiologists who derive consensus judgments based on the appropriateness of submitted case reports. If the group deems that a report should be changed or if no consensus could be reached, then the group must provide context, which is then shared.