In response to healthcare reform, a necessary evolution of radiology has shifted from generating volume to demonstrating value. Multidisciplinary tumor boards provide a critical opportunity for radiologists to demonstrate their value to their clinical colleagues, their patients, administrations, and society.
Introduction
In the last two decades, many radiologists were satisfied with and well compensated for their work producing high volumes of radiology reports in quiet, dark reading rooms. That outdated paradigm of the fee-for-service model of reimbursement resulted in limited interaction with patients, referring clinicians, and administrators. Radiologists traditionally could be described as image interpreters who thrived in the model that rewarded radiologists based on volume. However, the eventual fragmentation of imaging services and the advent of teleradiology led to radiologists becoming almost invisible .
There is a demand for a new generation of radiologists who provide services beyond producing high volumes of dictated radiology reports. This is more than a revolutionary way of looking at radiology; it is an evolutionary process that is vital to the relevance and longevity of this specialty. A new age of medicine has evolved as radiology moves from a fee-for-service model centered on volume toward a patient-centric, value-based model. This cultural transformation demands that radiologists expand their role in the healthcare system to that of expert diagnostic imaging consultants. Instead of focusing on volume, value is prioritized, which is essentially determined by referring healthcare providers and patients as consumers .
Value-based healthcare focuses on the right patient receiving the right examination at the right time. This improves patient quality while reducing cost . Centers for Medicare and Medicaid Services (CMS), the largest payer in the United States, is ambitiously targeting a shift in healthcare reimbursement, with the goal that 85% of all fee-for-service payments will be linked to quality or value metrics by the end of 2016, with 30% alternative payment models by 2016 and 50% by 2018 . Recently, the Medicare Accountable Care Organizations 2015 Performance Year Quality and Financial Results reported that over 400 Medicare ACOs generated more than $466 million in total program savings in 2015, accounting for all ACOs’ experiences. Of these, 125 qualified for shared savings payments by meeting quality performance standards and their savings threshold .
So how do radiologists step away from the reading room and demonstrate their value as members of the healthcare team in this new era of healthcare? One answer is by participating in multidisciplinary tumor boards (MTBs), formal meetings in which networks of specialists devoted to the care of cancer patients meet to discuss diagnosis and management. These meetings often involve core groups of medical oncologists, radiation oncologists, surgeons, radiologists, and pathologists, as well as other ancillary members of the healthcare team. Patients discussed in these meetings predominantly have newly diagnosed cancer but also may include those at high risk for cancer or patients with complex management questions, such as discordance in biopsy results. Using the approach to the diagnosis and treatment of breast cancer as a model, herein we describe how active participation and engagement in MTBs provides opportunities for radiologists to align with the value expectations of current healthcare reform. This model can be extended and applied to other specialties in radiology, as well as other multidisciplinary conferences. Several of the principles presented here could potentially be applied to other payment paradigms, but this article will focus on the value paradigm, which is being advocated by CMS.
The specialty of radiology needs to adapt to the current shift from volume-based to value-based healthcare. Quality interpretation of radiological findings via traditional written radiology reports is merely a starting point for radiologists in shaping America’s healthcare system. Radiologists must be willing to step out of the comfort zone of the reading room and interact directly with patients and referring clinicians. MTBs provide an ideal opportunity for radiologists to interface directly with referring clinicians and become engaged in the care of cancer patients. Active participation in MTBs shows a willingness of radiologists to collaborate with healthcare providers in other disciplines, demonstrates the critical role that radiologists play in the full spectrum of patient care, and prevents the commoditization of radiologists. Radiologists earn the confidence of referring physicians, gain credibility with hospital administrations, and increase their personal job satisfaction through direct interaction with the multidisciplinary team. Building trust and fostering relationships with clinicians and other healthcare professionals at the local level are essential steps in demonstrating the relevance of radiology to the professional community at the regional and national levels, at which radiologists must be seen as relevant and indispensable members of healthcare systems and society . MTB participation is, therefore, a significant opportunity for radiologists to align with the emerging value paradigm of radiology. Active radiologist engagement in MTBs achieves this by aligning radiologists with essential facets of healthcare: patient quality and safety, education, advocacy, research, and economics.
Patient Safety and Quality
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Education
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Advocacy
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Research
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Economics and Value
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Conclusions
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