Localized expertise: Cementing the radiologists’ role on the care team

Increasing meaningful, one-to-one interactions at the local level can help radiologists continue to have positive influence on the providers who order imaging exams, according to an article published in the December edition of the Journal of the American College of Radiology.

Authors Daniel J. Durand, MD, with Evolent Health of Arlington, Va., and colleagues looked at various strategies radiologists can employ to maintain positive relationships with providers in the care setting.

Durand and colleagues noted that radiology’s role has always included consultation over appropriate imaging exams, aiming for “the right test at the right time for the right patient.”

More recently, however, their role in the pre-exam consultations has been minimalized.

“During the fee-for-service boom of the early 2000s, health care systems derived up to 37 percent of their profits from radiology while also using imaging to minimize wait times and maximize throughput for other high-margin service lines such as orthopedics and oncology,” Durand and colleagues wrote.

The authors contend radiologists now often find themselves both judged and paid in a unit-based productivity method that discourages consultation with ordering physicians for three reasons:

• When radiologists aren’t reading exams or writing reports, they aren’t generating revenue;
• Radiologists carry the risk of “friction” with providers; and
• Successful interactions can result in exams not being ordered which results in lost revenue.

“With all change comes opportunity,” the authors wrote, insisting that despite cost-cutting measures and a focus on bottom line profits, physicians still welcome and seek out consultation from a radiologist over a benefits manager or computerized decision support system.

Duran and colleagues outlined several methods radiologists can undertake to assist ordering physicians.

One such project is a plan-do-study-act plan (PDSA), which authors claim, despite the work-heavy aspect of developing initial questions and corresponding appropriateness interventions, assist ordering physicians in making a SMART (specific, measurable, attainable, realistic, timely) performance target.

Another method radiologists can use to assist ordering physicians is through imaging consultation services, which often is more about aligning a radiology department’s capabilities with an organization’s goals when it comes to service. Consultation services can include:

• Individual radiologist consultation services
• Clinical decision support algorithms and software
• Radiology benefits management solutions

The authors also offered radiologists tips on asserting their role as valuable and visible members of the care team.From suggestions as simple as being present in work areas or accompanying physicians on their rounds, Durand and colleagues emphasized being visible in the daily realm of the healthcare setting is essential to positively impacting the behavior of ordering provider.

“To a certain extent, the norms of radiologist consultation and existing interspecialty relationships are important variables that can be factored in at only the local level,” the authors wrote.