Value-based care is expected to transform supplier-created demand into patient-relevant demand, emphasising services that add value to patient care and minimising services that do not.
This shift from fee-for-service to a value-based care model has implications for the field of radiology because if imaging and image-guided intervention services do not add value, or if their value cannot be understood and appropriately measured, then the importance of radiology in a value-based care environment could be minimised.
Dr Yoshimi Anzai, Professor of Radiology – University of Utah, U.S., gives an overview of the healthcare payment models in the US and the recent pressure toward the price transparency of ambulatory services, including radiology.
She further discusses how consumers (patients) balance price (cost) and quality of healthcare services.
Anzai explains, “Payment is based on volume. That needs to be changed to focus more on the value and outcomes for patients. There has been a continuous decrease in reimbursements for imaging. The rising cost of healthcare has led to double-digit growth in the insurance premium. Small employers have stopped offering health insurance or redesigned the plans with cost-sharing to employees.”
In the US, within the High Deductible Health Plan (HDHP), a patient must spend over US$5000 before getting any benefit from the insurance companies.
Also, there is a wide price variation for imaging studies. Therefore, in 2020, the CMS Price Transparency Rule highlighted that hospitals must disclose standard prices of 300 “shoppable” services. These are non-urgent services that include imaging or ambulatory surgery.
The value of imaging can be demonstrated through quality and service such as accurate and timely diagnosis, and high quality of imaging.
“For healthcare, it is not just about price or cost, but about ensuring superior quality and providing value,” she says.
“Also, radiology is one of the most mentally demanding physician specialities with workload likely contributing to burnout, and this is where Artificial Intelligence/Machine Learning can play a crucial role in assisting with day-to-day operations.”
Carlos Francisco Silva, MD, EDiR, Radiologist, Member – Management & Quality Section, Portuguese Society of Radiology and Nuclear Medicine (SPRMN), Sertubal, Portugal, discusses the concept of value in radiology. He says that value equals to outcomes divided by cost. The outcomes include quality, efficacy, and safety.
He further highlights that radiology faces the problem of 30 per cent of waste in imaging exams due to tests and procedures that are unnecessary.
Some of the frequent mistakes that can lead to this waste include forgetting to compare previous CT/MRI reports, missing information, a valid information request but about the wrong patient, and missing/erroneous lab data.
“Good IT support is crucial for radiologists to integrate the necessary software and clinical decision support tools, otherwise they will lose too much time,” he stresses.
Furthermore, according to Silva, even though physicians are aware of the problem they continue to order low-value tests and procedures.
He shares findings where the reasons for this included malpractice concerns (87 per cent), desire to reduce uncertainty (84 per cent), “just to be safe” (78 per cent), and desire to keep patients happy and on patient’s insistence (>70 per cent).
He adds: “While value-based care needs to be relationship-centric, radiologists need to work as a team, and align clinicians’ value and goals to achieve better patient outcomes.”
When asked about the future of radiology, Anzai concludes by saying that imaging provides valuable information to physicians and healthcare workers, therefore, imaging will get faster to obtain, and its efficiency will continue to improve.
Radiologists, working alone or as parts of collective departments, must understand the principles underpinning cost allocation and the value-chain concept, and must take value-based healthcare into account when planning, developing and delivering their services.
By embracing value-based healthcare principles, and striving to create value where possible, radiology can contribute greatly to moving from a volume-driven system to a value-driven one, where as many investigations or interventions as possible contribute positively to patient outcomes.
