What is happening in the quality measures world?
There's a lot of interest in performance measurement for clinicians. The ACR wants radiologists to be able to participate in registries and initiatives like the Quality Payment Program in ways that are directly relevant and reflect their practices. So, it's important to have performance metrics that are meaningful to radiologists as they actually practice and interact with patients. You also have to have a spectrum across subspecialties.
Why is it important to have meaningful quality metrics?
It's important to radiologists to have measures that are meaningful and achievable for a couple of reasons. One reason is that they are often tied to payments. Under the MACRA law, there was a shift to pay for value as opposed to the volume of service. For the majority of radiologists, there need to be radiology-specific metrics that we can report. So, the ACR has worked to construct a portfolio of measures that are relevant to the majority of radiologists.
How are new metrics being developed for radiologists in 2018 and beyond?
In the latest round of measure development
, we thought it was important to facilitate the participation of radiologists in a wide variety of practice settings. So, we focused on incorporating incidental findings recommendations and tried to structure feasible, specifiable metrics that will allow radiologists to demonstrate that they are following the latest guidelines for the management of incidental findings. The other area we're looking at is radiation exposure. We've focused metrics on instances where patients are likely to have repeat studies and where the literature supports adequate diagnostic quality at lower doses for answering the relevant clinical questions in certain specified populations (for example, kidney stone patients and children with cerebral ventricular shunts).
Who is involved in developing new metrics?
It’s a collaborative effort, both within the radiology community and across other specialties. We've had important and crucially contributory participation from urologists and internal medicine, family practice and emergency physicians. And members of the Metrics Committee have spent considerable time and energy trying to get this right. We've had representatives from community practices and academic practices, from neuroradiology, body imaging, pediatric radiology, musculoskeletal, nuclear medicine and other subspecialties.
What is the process like to develop the optimum set of metrics?
It is a very thorough, rigorous process to create the measures and get them tested and approved. We always want to ensure that the quality metrics we are developing for radiologists are sustainable, meaningful and measurable. Here’s an overview of the process. First, we solicit ideas from a wide range of people — typically within various committee structures in the College. Then we look at guidelines on those topics. We consider the Practice Parameters and Appropriateness Criteria within the College. And we look at the guidelines and literature of other specialties. Everything we do is in the context of the totality of patient care.
We try to find gaps where guideline-recommended care is not being delivered or areas where care that might be low value or detrimental is being delivered. We also consider situations where the reporting structures are not as helpful as they could be — for example, lack of consistent reporting of stenosis on carotid imaging studies. Who knew that would be so hard? The bottom line is that we’re always looking for new measures where radiologists can be successful in quality improvement.
What about the impact of quality measures on patient care?
Radiologists aren't just pursuing quality improvement for reimbursement, they're doing it to enhance patient care. And they're actively looking for areas where they can achieve measurable quality improvement. People want to know what doing a good job looks like, and they want to know what their professional society defines as performing well. These are aspirational goals to achieve. Every practice can pick an area where they want to excel, and they can have a defined structure under which to measure and improve. As a result, you can do a better job reading films, a better job communicating with referring doctors and a better job taking care of your patients.
What’s the benefit of gathering public comment on the proposed quality measures?
Before we go into testing measures in practice settings, we want to gather feedback from as many sources as possible. So, we’re putting the proposed measures on a site for public comment because we want to make sure that real people in the real world who are going to be applying these metrics aren't seeing problems with them that we didn't anticipate. Sometimes there are tradeoffs to be made or mitigating factors to be considered. Sometimes we say, "You know, we didn't think about that. Let's go back to the drawing board on this one." There are a lot of smart people out there, and you never know where the good ideas are going to come from, so you try to cast as wide a net as you can.
What's your advice to your colleagues about getting involved in quality measures?
Don't accept the status quo. If something bugs you, speak up. Medical professionals are given enormous trust and responsibility by society. It’s incumbent on us to live up to that trust. If you think there’s a systemic problem, and you can think of a way of measuring and improving it, say something. Make your voice heard. Volunteer when there are calls for volunteers. Say yes to whatever opportunity is offered. If you can think of a way to make the world a better place, go for it.