Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations

PurposeThe aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs).MethodsUsing CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time.ResultsBetween 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, and the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 versus 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% versus 38.5%), and ACOs with radiologists had a higher rate of specialist representation (56.0% versus 33.7%). Beneficiary age, race, and sex demographics were similar among radiologist-participating versus nonparticipating ACOs.ConclusionsIn recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.     

The Disruptive Radiologist

Radiologists interact with many individuals during daily practice, including patients, technologists, and other physicians. Some interactions may potentially negatively affect patient care and are termed “disruptive” behaviors. These actions are not uncommon and may begin during training, long before a radiologist enters clinical practice. The causes of disruptive behavior are multifactorial, and it is important that educators and radiologists in practice alike be able to identify them and respond accordingly. An escalated approach for both trainees and practicing radiologists is recommended, with substantial penalties after each incident that can include termination of employment. Training programs and practices must have clearly defined methods for confronting this potentially time-consuming and difficult issue.     

Integration of the Community-Based Academic Radiologist With the Academic Radiology Department: A Strategic Imperative

Academic radiology departments are expanding into the community with deployment of community-based academic radiologists (CBARs). The remote practice locations, unique workplace challenges, and limited opportunities for meaningful collegial interactions can become drivers for radiologist isolation, dissatisfaction, and burnout. Integration of CBARs with the academic radiology department with which they are affiliated is a strategic imperative to mitigate radiologist isolation and potential burnout. Committed physician leadership by the academic radiology department can support integration. Strategies to strengthen integration include bidirectional clinical coverage systems, pairing new CBARs with established academic radiologist mentors at the academic center, encouraging CBARs to serve on academic committees and collaborate on research projects with radiologists at the academic center, and recognizing CBARs for their achievements in the areas of clinical productivity, practice development, community outreach, collegiality, and innovation.     

The Breast Radiologist as a Public Educator: Designing an Effective Presentation for a Lay Audience

Educating the public about breast cancer screening and diagnosis is important. Medical and regulatory agencies encourage shared decision making about undergoing breast cancer screening, and there are many places women can get information and misinformation. The Internet and other media sources present information that may not be correct or understandable. Breast radiologists are uniquely qualified to provide women with the accurate information necessary to enable informed choices. As a specialty, we have an obligation to our community to provide relevant and understandable information. We can accomplish that through community outreach forums. Presentations should be understandable with plain language, focusing on our key message and using pertinent images or icons. Slides should be simple and avoid medical jargon or complex statistics. As we engage with the community, we provide a vital service to the health of our community and foster respect of our specialty.     

Focused Process Improvement Events: Sustainability of Impact on Process and Performance in an Academic Radiology Department

PurposeTo evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic radiology department.MethodsOur department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study.ResultsAll PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined.ConclusionsFocused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted.     

加强基层服务能力建设 做好百姓健康守门人

随着社会的进步、时代的变迁,人们的疾病谱也发生了根本性改变,在过去几十年里较为少见的糖尿病、高血压等疾病却成为现代人的高发病,新时代的"赤脚医生"——全科医生应运而生。全科医生以"五善"与六个"多一点"为行医守则,下沉社区居委会、患者家中,为慢性病患者、行动不便老人、残疾人等居家患者群体建立健康档案,送医送药,给居家患者群体带去了极大便利,构筑了健康中国的第一道防线,成为了名副其实的百姓健康守门人。     

Characteristics of High-Performing Radiologists Within Medicare Quality Programs

PurposeThe aim of this study was to assess radiologists’ performance on Medicare quality measures and identify physician characteristics potentially influencing such scores.MethodsMedicare quality scores reported by US radiologists in 2015 were obtained from CMS. Associations were explored with publicly available physician characteristic data.ResultsOverall, 15,045 radiologists reported 40,427 Medicare quality scores encompassing 25 claims measures, 18 registry measures, and 2 qualified clinical data registry (QCDR) measures. Claims measures included reporting fluoroscopic times (n = 10,152; mean score, 80.3 ± 27.6), carotid ultrasound stenosis (n = 8,940; mean score, 86.8 ± 20.6), inappropriate mammography use of “probably benign” (n = 8,083; mean score, 0.4 ± 3.3), mammography reminders (n = 7,229; mean score, 86.6 ± 29.0), bone scintigraphy correlation (n = 2,712; mean score, 76.0 ± 27.0), and line-related infection prevention (n = 2,226; mean score, 83.3 ± 27.4). Registry measures were reported by ≤17 radiologists. The two QCDR measures were dose index registry participation (n = 246; mean score, 99.5 ± 1.4) and mammography recall rate (n = 77; mean score, 9.0 ± 5.6). Higher scores were observed for radiologists in larger practices (strongest independent predictor), in subspecialized practices, in academic practices, in the South and West, and with fewer years in practice. The fluoroscopic exposure times measure had the best performance scores by musculoskeletal and interventional radiologists, carotid Doppler measure by abdominal radiologists, mammography measures by breast radiologists, bone scintigraphy measure by musculoskeletal and nuclear medicine radiologists, and line infection measure by interventionalists. The dose registry participation QCDR measure had near perfect performance across generalists and subspecialists.ConclusionsCurrent Medicare performance metrics favor radiologists in larger practices and subspecialized radiologists, possibly reflecting support infrastructures and the narrow focus of most metrics, respectively. These findings may assist targeted data-driven reporting by radiologists and guide efforts to refine existing and develop new metrics.     

Importance of enjoyment when promoting physical exercise

The purpose of this study was to investigate the importance of enjoyment of exercise in a health care-based intervention aimed at promoting physical exercise in primary health care patients. In a controlled study design, the intervention group was offered a wide range of group exercises over 3 months, followed by support in designing their own exercise program. The control group received usual care. Enjoyment of exercise and exercise level were measured. Associations between enjoyment and exercise level were analyzed using Spearman's rank correlation coefficients. Changes in enjoyment between and within study groups were analyzed by the independent and paired t -test. Associations were found between enjoyment and exercise level ( r =0.36, P <0.01), as well as between changes in enjoyment and changes in exercise level ( r =0.34, P <0.01). At the 12-month follow-up, enjoyment of exercise was 25% higher in the intervention group than in the control group ( P <0.01). In this group of primary health care patients, enjoyment of exercise was associated with exercise level. Enjoyment of exercise seems to be a mediator of exercise level. Furthermore, health care-based interventions seem to be able to affect enjoyment of exercise. Enjoyment of exercise may be important for the long-term effectiveness, of health care-based interventions.     

The Success and Failure of a Radiology Quality Metric: The Case of OP-10

PurposeMedical quality metrics can serve various functions, including promoting quality improvement efforts within a medical system, and providing a basis for comparing quality among institutions. OP-10, an imaging efficiency quality measure based on the number of CT scans of the abdomen performed both with and without contrast is broadly used and publically reported, but it has not been investigated in actual practice.MethodsIn this project, we report on both a successful quality improvement effort built around measurement of OP-10, and on the identified potential limitations of OP-10 itself for comparing among institutions. We performed two quality improvement interventions in 2012 and 2014 directed at OP-10, encompassing building of institutional practice standards via creating multidisciplinary consensus, educating radiologists and clinicians, revising CT protocols, and providing performance measurement and feedback. Results were extracted from the radiology information system and analyzed using interrupted time series segmented regression and statistical process control charts.ResultsThe proportion of inappropriate abdominal CT scans with and without contrast under OP-10 decreased, from 3,041 of 13,855 (21.9%) to 691 of 6,006 (11.5%) (P < .0001). However, 262 of 691 (37.8%) of the CT scans labeled as potential overuse by OP-10 could be considered appropriate under national guidelines. These discordant cases clustered in specific clinical areas (eg, urology and hepatology), indicating potential for bias against centers that serve referral populations in these areas.ConclusionsWe conclude that OP-10 can be useful to drive internal quality improvement efforts but is potentially biased when used for interinstitutional comparisons.     

Radiologist Group Performance Reporting: Power in Numbers

PurposeRadiologists have historically participated as individuals in CMS pay-for-performance programs, but little is known about how radiologists perform under increasingly available group participation. We aimed to assess radiologists’ relative national performance on CMS quality metrics using group versus individual participation.MethodsRadiologists’ group- and individual-level 2016 performance on Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR) measures were obtained from the CMS national Physician Compare database and compared.ResultsRadiology groups reported an average 4.6 ± 2.0 quality measures; individual radiologists reported 2.3 ± 1.2 (P < .001). At least six measures were reported by 31.5% of groups versus 1.0% of individuals. Only one measure was reported by 5.4% of groups versus 33.0% of individuals. Groups reported 21 unique measures (20 via registries and one via QCDR). For 8 of the 11 measures reported by 20 or more groups, the average group performance rate was 3% or better than the average performance rate among radiologists participating as individuals (maximum 14% improvement with group participation versus individual participation for any individual measure). Group and individual performance were similar for the remaining three such measures. For measures reported by 20 or more groups in which a higher score indicates better performance, average group performance rates ranged from 86.2% to 98.9%.ConclusionCompared with individual participation in CMS quality performance programs, radiologists participating as a group reported larger numbers of quality measures and achieved higher performance rates on those measures. Radiology practices seeking success under Medicare’s new Quality Payment Program should carefully explore group participation.     

军队医院信息系统的现状及对我军的展望

医院信息系统是在医院内建立以计算机为中心的系统网络，其目的是实现医院信息管理的现代化，近年来计算技术，通过技术等信息技术的发展，为医院信息系统的发展提供了有力的技术保障，本文介绍了国内国队医院的信息化建设的发展过程及现状，展望了我军医院信息系统的发展方向。     

Predictors of MRI Leakage Among Patients Attributed to an Academic Medical Center Commercial Risk-Shared Insurance Contract

PurposeFor health care organizations engaged in risk-shared insurance contracts, leakage of advanced diagnostic imaging to imaging sites not affiliated with the risk-sharing organization may undermine performance on financial and quality metrics. The goal of this study was to identify factors that are predictive of leakage of MRI examinations among patients attributed to an academic health care organization’s risk-shared commercial insurance contract.MethodsAdministrative claims data from 2015 through 2016 for patients attributed to a single risk-shared commercial insurance contract at a large academic medical center (AMC) were analyzed. Primary outcome was MRI leakage: an outpatient MRI study performed at a site not affiliated with the AMC’s integrated health care system. Ordering provider alignment with the AMC’s risk-shared insurance contract was categorized as strong, weak, or none. Multivariate regression analyses were conducted to evaluate the relationship between provider alignment and MRI leakage, while adjusting for selected covariates.ResultsAmong 8,215 patients meeting inclusion criteria, there were 13,272 MRI encounters. The overall proportion of leaked MRI studies was 12.7%. MRI studies ordered by providers with weak AMC alignment (odds ratio, 3.16; 95% confidence interval, 2.49-4.02) or no AMC alignment (odds ratio, 3.68; 95% confidence interval, 3.12-4.33) were more likely to leak than MRI studies ordered by providers with strong AMC alignment.ConclusionsAn ordering provider with no alignment with an AMC’s commercial risk-shared insurance contract was the strongest predictor of MRI leakage. Population health management initiatives aimed at reducing leakage should consider the impact of provider networks and clinical referral patterns that drive imaging utilization.     

The “night stalker” effect: Are quality improvements with a dedicated night call rotation sustained?

The authors assessed whether the addition of a second-year diagnostic radiology resident assigned to cover the night shift at a major urban university hospital has a sustained effect on the number and clinical significance of “missed” radiologic findings. Radiographs interpreted overnight in the emergency department by radiology residents between January 1992 and December 1992 were reviewed daily by emergency radiology attending staff. A list of patients for whom there was a modification in the final radiologic interpretation was given to the emergency department physicians, who reviewed each case, scored the urgency of patient recall, and estimated the likelihood of patient morbidity attributable to the miss. The relative performance of after-hours residents was compared on the five nights per week with the dedicated night resident vs. the two nights per week without the dedicated night resident (control group). Of 22,295 after-hours examinations performed during the study period, 304 (1.36%) misses were recorded, nearly identical to the miss rate for the preceding 6 months. The percentage per examination interpreted (and number) of missed cases stratified by recall score for the control and dedicated night resident groups, respectively, were: (a) immediate, 0.62% (34) and 0.29% (49); (b) within 48 hours, 0.31% (17) and 0.32% (54); (c) no recall, 0.71% (24) and 0.29% (39); (d) finding already recognized by emergency department physicians, 0.44% (24) and 0.23% (39); total, 2.09% (114) and 1.13% (190). The difference in total discordance rates is statistically significant (P < 1 × 10⁻¹⁵). Our previously reported improvement in the quality of after-hours radiographic interpretation due to the addition of a dedicated night shift resident is sustained in a new group of residents. This confirms that the improvement is real and not a manifestation of the measurement methods.     

MRI: From science to society

In this 2012 ISMRM Lauterbur Lecture, my goal is to challenge the members of the ISMRM to think critically about how we approach our research. From the perspective of a leader of an academic health sciences center, which is also a health care delivery system, I address three specific questions:

• Are we developing great technologies?
• Are we advancing scientific knowledge?
• Are we advancing human health?

Specifically, with respect to increasing pressure in health care to improve patient outcomes and lower costs, I ask members to consider how we select the areas of research we focus on and whether we have sufficiently prioritized research that assesses the impact of our MR methods on patient outcomes. For imaging research to meet higher standards of evidence‐based medicine, multicenter consortia should be developed, potentially under the auspices of the ISMRM, and priority should be given to developing investigators with expertise in health services research. J. Magn. Reson. Imaging 2013;37:753–760. © 2013 Wiley Periodicals, Inc.