Patient safety expert Robert Wachter, M.D., told radiologists Sunday that they needed to reimagine their work to focus on where they think they add value to the health care system. On Monday, Vivian Lee, M.D., gave them suggestions on how to do that.
Lee, the CEO of the University of Utah Health Care four-hospital system and an MRI radiologist, said that her radiology colleagues can drive value by stepping up and taking responsibility for making more-accurate and timely diagnoses.
While speaking at the Radiological Society of North America’s 102nd annual meeting in Chicago, Lee referenced the Institute of Medicine’s 2015 report Improving Diagnosis in Health Care, which noted how diagnosis errors contribute to 10 percent of patient deaths and 28.6 percent of malpractice cases.
In addition, Lee talked about how more-accurate and timely diagnoses by radiologists could lead to shorter lengths of stay, earlier detection of diseases (and, consequently, less expensive treatments) and lower pharmacy costs. In particular, Lee noted how pharmacy costs were among the biggest drivers of healthcare inflation and how radiologists could help segment cancer patients to identify those who would receive the most benefit from expensive drugs and help find less costly and more-effective treatments for those who wouldn’t.
Labor expenses account for about 80 percent of costs in radiology, Lee said, so wider use of radiological assistants may be one way to reduce those. She also recommended “shortening the time we need that labor” by reducing the time it takes to conduct a radiological test. She cited cases of how knee MRIs, mammograms and other common imaging tests were successfully shortened.
Under Lee, the University of Utah system has been a leader in measuring labor costs and using data to enhance value. A report by Lee and her Utah colleagues was published in September in JAMA and showed how working to identify and reduce variability in costs can improve quality and patient outcomes for defined conditions.
It can also improve patient satisfaction scores for a health system, Lee said, as a diagnostic screening is often a patient’s first access point to receiving treatment at an institution.
“Imaging is front and center in the way we think of health care,” Lee said.
The focus on improving value and lowering costs is new territory for radiologists trained in the last 20 to 30 years, Lee said. “Our experience has been radiology in its heyday,” Lee said, and she cited how surveys looking at the greatest advances in modern medicine put imaging breakthroughs in MRIs, CT scans and mammograms at the top of the list.
Now, however, interest in radiology is waning among medical school graduates. Lee cited statistics from the Association of American Medical Colleges on how more radiology residency slots are going unfilled and fewer graduates of U.S. schools are applying for them.
Part of this is declining income and a declining reputation for radiologists. Lee showed a cartoon of a doctor and patient in an exam room with the doctor saying “First, we’re going to run some tests to help pay off the machine.”
As a demonstration of the current view of radiologists, Lee showed how Google finishes the sentence “Radiologists are ____.”
On top of the list were unflattering words like “parasites,” “overpaid” and “not doctors.” The good news, however, was that “the smartest” was also one of the phrases the search engine recommended for finishing the sentence.
The RSNA meeting runs Nov. 27–Dec. 2.