In light of our past webconferences on the outlook for imaging and the likelihood that management of ordering appropriateness may become a growing mandate for imaging admininstrators and radiologists, I wanted to point to this article in the Radiology Business Journal in case you missed it. The article profiles Grand Junction, Colorado, one of a few places singled out by Atul Gawande in the now-famous New Yorker article on health care costs and utilization. The article profiles Rocky Mountain Health Plan and the incentive payments they make to physicians for higher quality, lower cost care. The health plan witholds 10 to 15 percent of each physician's professional claims and holds the money in a savings account. If the health plan meets financial targets at the end of the year, physicians receive a bonus payout based on the withhold.
To safeguard against pure cost-cutting at the expense of quality, a number of quality measures are established that physicians have to meet in order to qualify for the bonus. The article discusses a couple of practices and technologies in place to help radiologists and ordering physicians manage to cost targets. Use of a RHIO to reduce double orderingWell-defined radiology department dashboards to monitor key cost and quality indicatorsLoad-balancing for managing the radiologist workload, and reducing interpretation costs for outlying sitesA database for ordering physicians to pick high-quality, lower cost providers
What I found most interesting though is the role the radiology department at one hospital plays in managing utilization:
"Because all players in the MCPIPA-RMHP health system stand to benefit from reduced costs, physicians and radiologists alike are motivated to curb utilization wherever clinically appropriate. "We're always looking for opportunities to be more efficient with the processes we have," Gorby says. "With radiology, these are very expensive pieces of equipment, and there's always new technology. We want to be good stewards in deciding what the best technology is for our environment, not bringing things in just because they're the latest and greatest."
Though the responsibility for ordering appropriate tests lies largely with primary care physicians, the radiology department at St Mary's plays a role. "We have a job title of radiology patient coordinator for a person who helps with scheduling and tracks procedures across the modalities to ensure greater efficiency," Voss says. Cruz adds that the person holding the position, a technologist, has excellent clinical judgment. The radiology patient coordinator serves as a liaison between radiologists and clinicians whose patients are thought to need certain procedures. Voss explains, "She's often able to help send the patient in the right direction, helping the referring physician make the appropriate choice."
Ongoing referring-physician education is conducted by RMHP, Fitzgerald says, to ensure that if a test is denied by the payor, the physician understands why. "We have recently done real-time education on cardiac PET/CT exams for ruling out acute myocardial infarction," he notes. "We use Milliman Care Guidelines®, and we call the ordering physician and say, 'We see your referral; here's why we're not approving this. May I send you the guidelines?' We do that on a regular basis," he explains."
While the environment in Grand Junction is probably different than that of most members, I think this story provides an interesting glimpse on future management imperatives regarding utilization. Even if health care legislation fails, imaging departments will be under more pressure to reduce unnecessary utilization in coming years as payers look to transfer more of the onus of ordering appropriateness scrutiny to providers in their quest to lower imaging costs.