Daily Bulletin 2016

Driving Value Through Imaging

Tuesday, Nov. 29, 2016

As healthcare moves from a volume- to value-based environment, radiologists need to own responsibility for accurate and timely diagnosis to drive value, according to Vivian S. Lee, MD, PhD, MBA, who delivered the Annual Oration in Diagnostic Radiology, "Health Care Transformation: Driving Value through Imaging."

"We are facing a pretty significant healthcare crisis in this country," said Dr. Lee, who is senior vice president of the University of Utah Health Sciences, CEO of the University of Utah Healthcare, and dean of the University of Utah School of Medicine. She pointed out that healthcare costs in the U.S. have increased by more than 50 times compared to the rate at which wages have increased over the last 50 years, "and this increase in costs is simply unsustainable."

Vivian S. Lee, MD, PhD, MBA

Vivian S. Lee, MD, PhD, MBA, delivers the Annual Oration in Diagnostic Radiology.

To make matters worse, she added, despite the world's highest per capita healthcare expenditures, "the U.S. falls woefully short in most measures of health quality or outcomes," when compared to other Organization for Economic Cooperation and Development (OECD) nations.

So the question, according to Dr. Lee, is how do we focus our healthcare delivery system on value?

Which begs the question of how value is defined.

She pointed out that her home state of Utah has the lowest healthcare cost per capita in the country, yet constantly ranks high among the other 49 states in terms of the health of its population.

Dr. Lee explained that the University of Utah Health Sciences thinks about value with a very simple equation: how quality and service can be combined at a reasonable cost.

In the case of the University of Health Sciences, the institution is providing better quality (it is ranked number 1 in quality as determined by quality rankings of 100 academic health centers), while national benchmarks for patient satisfaction scores show that 24 percent of Utah Health providers rank in the top 1 percent of providers, 44 percent rank in the top 10 percent.

"At the same time, we have been very attentive to costs," Dr. Lee said. "We are among the lowest cost academic systems in the country."

Dr. Lee went on to describe how—at a system level—her institution and others like it are "thinking about the need to drive more toward value, to measure quality, to measure patient satisfaction, to feed that data back to providers, and give them the opportunity to respond to that and improve."

And what role will radiology play in this process?

"I think without a doubt those of us who have trained in the last 20 or 30 years will say we have had an enormous impact on the field of medicine," Dr. Lee said.

However, as she pointed out, it seems like radiology has been under siege since the turn of the century, with downward pressure on reimbursements, a declining job market, and a decrease in the number of medical students going into radiology.

"There are clearly some questions about the value of our role and the value of our field," she said.

Speaking as a healthcare executive, Dr. Lee said that in a world in which radiology is moving from being a profit center to a cost center, health systems need new perspectives from their radiology colleagues to help them think about really driving value. She asked the audience to consider, "How can you help our health systems succeed?"

Dr. Lee focused on specific areas of "vulnerability" for healthcare systems, such as earlier diagnosis and reducing misdiagnosis, appropriate and timely management of complex patients, and the reduction of pharmacy costs. "These are all vulnerabilities in our health systems that we need help on," she said.

For example, Dr. Lee said, efforts to achieve more effective teamwork, better IT support for diagnostic processes, and appropriate work systems and cultures, will be useful in helping health systems reduce diagnostic errors.

"There is no leadership in this space," Dr. Lee said. "So this is a perfect opportunity for radiologists to step up and say we own this space."

Dr. Lee also noted that the high cost of certain drugs is another vulnerability for health systems. At the University of Utah, for example, pharmacy costs for most patients were down last year, yet 1 percent of the most complex patients accounted for 13 percent of total pharmacy costs.

And one of the biggest areas of these costs are cancer drugs, with some drugs costing as much as $30,000 per dose. Furthermore, Dr. Lee pointed out, in many of these cases the percentage of responders is 20 to 25 percent. Therefore, a specialty like molecular imaging can be very valuable in identifying patients who are really going to benefit from the most expensive drugs.

"These are the areas I hope our field will contribute to," Dr. Lee said. "Drive the value of imaging by using imaging to assess the value of new tests, new drugs, and new devices, and integrate imaging into better clinical diagnosis and better decision making."

Question of the Day:

I want to buy a new mammography unit, but it has a tungsten target. Don't I need the characteristic x-rays from Molybdenum to have the optimal energy range for breast imaging?

Tip of the day:

Dose alerts are set for equipment as a complete unit. This means it may help prevent overdosing a patient, but it also means that the alert may kick in during a high-dose procedure like CT-fluoroscopy and interrupt imaging. Always make sure someone in the room has the password to override when performing high dose procedures on dose alert enabled equipment.

The RSNA 2016 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.