Opinion: Physician autonomy key to outcomes improvement

The only true measure of the value a physician brings to the U.S. healthcare system is the degree to which he or she helps bring about good clinical outcomes.

That said, in breast imaging, part of a good clinical outcome is the establishment of a physician-patient relationship that helps both parties comply with evidence-based medicine while drawing on data-driven best clinical practices, the patient’s priorities and the physician’s autonomously exercised clinical expertise.

All that together may sound like a tall order, but radiologists specialized in women’s imaging who achieve this multi-pronged value proposition will improve their science and preserve the art of medicine.

So say three members of the department of radiology at Northwestern University’s Feinberg School of Medicine in an opinion piece running in the February edition of the American Journal of Roentgenology.

“A physician-patient relationship can result in an educated, loyal and compliant patient,” write Dipi Gupta, MD, and colleagues. “Forging this relationship is an essential component of physician autonomy, and a clinical environment supportive of this relationship would be of benefit to patient satisfaction and outcomes and to the bottom line of the institution.”

The authors cite their own institution, Northwestern’s Prentice Women’s Hospital, as an example of a breast-imaging program whose improvement may hinge on the healthcare system’s capacity to get better at recognizing true value.

At Prentice, diagnostic mammography exams are scheduled in 15-minute intervals. This, Gupta and colleagues point out, sometimes results in the curbing of direct communications between physicians and patients.  

“Are we measuring the right thing? It seems that value-based reimbursement has become metric-based medicine,” they write. “In our eagerness to add value, we have forgotten the numerator of the equation: health outcomes.”

“Physicians support value for improved patient outcomes, not poor surrogates for outcomes,” the authors add. “Checking boxes to avoid penalties is not likely to get us to the promised land of value-based healthcare.”

Gupta et al. further state that talking about cutting costs without paying close attention to improving outcomes is “irrelevant and dangerous.”

“The reality is that there is no substitute for measuring and reporting outcomes,” they write. “Success will involve collecting data on measures that improve health outcomes and linking those measures to reimbursement.”

The current metrics used for value-based reimbursement, such as report turnaround times, “are surrogate measures that do not measure health outcomes directly,” the authors conclude. “The true measure of a physician’s value in medicine is the accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. This relationship is one that requires a physician's time and judgment—that is, physician autonomy.”