Medical imaging procedures have become a national target in the campaign to reduce wasteful practices. At a minimum, radiology residency programs must integrate high-value curricula and train residents to practice in accordance with value-based principles and new healthcare policy. A greater portion of radiology resident education needs to be devoted to appropriateness education and consultancy training. Ideally, radiology training programs will instill in residents the importance of embracing the movement and leading the change.
With the creation and implementation of the Choosing Wisely recommendations, medical imaging procedures have become a national target in a campaign to reduce wasteful practices. At present, >100 of the recommendations by non-radiology societies aim to decrease inappropriate imaging . Clinical decision support software to guide the ordering of expensive imaging tests will soon become mandatory nationally for reimbursement purposes. At a minimum, radiology residency programs must integrate a high-value curriculum and train residents to practice in accordance with value-based principles and new healthcare policy. Choosing Wisely and ACR Appropriateness Criteria (AC) are critical resources for radiology residents to utilize in their consultations with other providers . Additionally, for residents to be effective in their roles as champions of high-value imaging, they must understand the importance of protocol design for modalities like computed tomography and magnetic resonance imaging .
Several challenges arise in the face of this paradigm shift from a volume-based reimbursement model to a value-based model, which could be perceived as threats to radiology training programs and radiology as a career choice. The core of radiology training is case volume, guided by the principle that interpretation of a large number of cases in training is the best means of building diagnostic accuracy, diagnostic confidence, and efficiency. In that regard, it is important that medical students and residents understand that imaging volumes will not be substantially reduced, but rather refined. The exponential growth of imaging over the past decades has been driven by diagnostic innovations, which will continue to advance our field. Inappropriate and unnecessary imaging will be replaced with carefully selected diagnostic imaging tests that provide valuable information to guide patient management. Similarly, a shift to a value-based model may be perceived to conflict with income and career potential. In simple terms, some may assume that by decreasing volumes and therefore decreasing relative value units, salary reductions are inevitable. However, in the long run, reimbursement will be greatest for practices that deliver high-value care.
Ideally, training programs will instill in residents the importance of embracing the movement and leading the change . Radiologists are best suited to define value with respect to imaging and to educate providers about best ordering practice. A greater portion of radiology resident education needs to be devoted to appropriateness education and consultancy training . Rather than rely on radiology benefit management firms, which fragment the provider–radiologist relationship, training programs must integrate radiology residents into the hospital’s medical and surgical patient care teams, outpatient care facilities, and multidisciplinary conferences . Similar to the interactions afforded by “radiology rounds,” which became obsolete in many institutions following implementation of PACS (Picture Archiving and Communication System), residents need to serve as both the teacher and the learner with other residents and attending physicians outside of radiology. Obviously, a balance needs to be struck to ensure core radiology training is not stymied by this venture. Fortunately, the fourth year of training provides elective time to integrate these roles after residents have mastered the knowledge base required to pass the Core exam and are sufficiently experienced to be respected by faculty.
This transition is an incredible opportunity for radiology to advance as leaders in healthcare quality and safety. To ensure long-standing improvements in practice, appropriateness education and professional development as consultants must be expanded in radiology training curricula. In addition, the transition will eventually draw medical students into our field, as we gradually become more integral members of each patient’s healthcare team.
References
1. American Board of Internal Medicine foundation : Choosing Wisely. Available at: http://www.choosingwisely.org Accessed August 12, 2016
2. American College of Radiology : American College of Radiology Appropriateness Criteria. Available at: http://www.acr.org/quality-safety/appropriateness-criteria Accessed August 12, 2016
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