How do we enhance patient care and contain costs? By determining IF a radiology imaging test is necessary. The question that too often is being asked, by regulators aiming to contain costs, is how many imaging tests were ordered or performed. A given patient population may require more imaging tests than another. Regulators attempt to determine the answer to "how many" and "how much" with cost-cutting algorithms that may not be appropriate on a case-by-case basis.
Patient care can improve with decision support models such as ACRSelect, which is a program that is designed to assist medical providers when ordering radiology imaging tests/procedures. Using ACR Appropriateness criteria, the use of ACRSelect can improve the ordering process by ensuring that tests that are ordered are appropriate from an evidence-based standpoint.
But much more is needed than a passive, front-line, computer order entry assistant.
Radiologists are in the best position to assist our clinical colleagues when ordering radiology imaging tests and procedures. While ordering tests/procedures has traditionally been thought of as the purview of the "ordering" physician, few know better than radiologists the irony of the federal regulators who continue to look to radiology as a source for reimbursement cuts.
When I first started residency, we radiologists were sort of still functioning in the role of "gatekeepers," an adversarial-sounding term that has unpleasant connotations to both radiologists and referring clinicians alike. For example, as a resident on overnight call, we would discuss with the ordering physicians, typically other resident physicians, whether the test they were requesting was appropriate and why. Such discussions, you might imagine, could easily become contentious considering that the person attempting to obtain the test felt it was needed and often didn't understand why an explanation was necessary.
But in today's cost conscious world, such discussions are necessary, and are even required if we are to wend our way through appropriateness criteria and cost-effective care. Eliminate the puerile contentiousness and enhance the collegiality of the interaction and you have the makings of a helpful interaction designed to enhance patient care. Closed-door radiologists are anachronistic. Although few radiologists have their phones always on and their doors always open like I and many of my partners do, it is imperative to do so now. The current goal of the American College of Radiology, with Imaging 3.0, is to demonstrate the continued value of radiologists in the patient care paradigm.
We radiologists have a fund of knowledge at our fingertips that can assist our clinical colleagues in their efforts to care for their patients. And what our clinical colleagues know about their patients can help radiologists to contribute more effectively to patient care through collaborative discussions.
By utilizing the expertise of the local radiologist, answers can be obtained to seemingly difficult questions. By visiting the radiologist in the reading room when possible, face to face discussions can be held about patient care nuances. The value of complementary imaging studies can be discussed and the optimal study can be identified.
The day has arrived for radiologists to be more involved with the ordering clinicians to ensure that the appropriate test is ordered. Radiologists offer value to patients and clinicians alike by being involved in the decision-making process.