Why radiologists must reevaluate the imaging value chain

Radiologists should look within and reevaluate the imaging value chain in order to energize a cohesive healthcare system that can be measured by quality, service and business growth metrics, says Rasu B. Shrestha, vice president, medical information technology, at the University of Pittsburgh Medical Center, in a recent article for Applied Radiology.

According to Shrestha, the move toward accountable care and value-based imaging means that the radiologist should be focusing on addressing medical conditions that are part of a broader integrated team, not individuals or one specialty.

And while radiologists rarely have full control over the value delivered to patients--with the possible exception of women's imaging and interventional radiology--they should, he adds, be "fully aware of the care cycles around the patient and ensure that we are able to affect care in an integrated manner both upstream and downstream to ensure good, measurable patient results with accountability tightly couple to results and outcomes."

Shrestha refers to a book by Michael Porter and Elizabeth Olmsted Teisberg called "Redefining Health Care" in which they argue that problems associated with healthcare delivery have been worsened by dysfunctional competition.

Competition, he says, is dysfunctional in two senses. First, Shrestha says, it's too broad because it takes place at the "level of health plans, networks, hospital groups and clinics, and not and not in addressing particular medical conditions." Additionally, he says, it's too narrow in the sense that it takes place "at the level of discrete interventions or services and not over the full cycle of care that includes prevention, diagnosis, treatment, monitoring, and management of a condition.

"Value in healthcare is created [or destroyed] at the medical condition level, not at the level of a hospital or physician practice," he writes.

Transforming healthcare delivery will involve evaluating the healthcare delivery value chain across entire cycles of care around particular medical conditions, he writes, which should reveal "gaps, duplication of tasks, redundant testing and numerous other inconsistences that were previously assumed as normal practice."

Last spring, the American College of Radiology's Radiology Integrated Care Network (RICN) published an opinion piece in the May issue of the Journal of the American College of Radiology encouraging radiologists to proactively become involved in accountable care organizations.

"There are numerous practical lessons that can be learned and will be shared with other ACR members through RICN's activities," wrote RICN Chair David Rosman, M.D., and his colleagues. "One overwhelming initial conclusion is that radiologists must be engaged in the development and operation of these 'new' healthcare delivery models."

To learn more:
- read the article in Applied Radiology
- read more about "Redefining Health Care"