HIMSS16: The impact of radiology's transition to value-based care

Radiology continues to go through significant changes in 2016. Shawn Griffin, MD, chief quality and informatics officer of the Houston-based Memorial Hermann Physician Network (MHMD), discussed the profession’s transition from volume- to value-based care earlier today at the HIMSS Annual Conference in Las Vegas.

Griffin spoke with RadiologyBusiness.com before his presentation, saying he thinks the transition will help reduce unnecessary tests throughout radiology.

“I think many radiologists would agree with me that there are some tests that are being done that shouldn't be done on patients, and that encouraging evidence-based guidelines for whether a test is done in the first place is useful,” Griffin said. “We probably have room for reducing some needless tests.”

Evidence-based medicine is growing more and more important in radiology, Griffin explained, sharing the story of how MHMD helped reduce the number of area children getting head CT in the emergency room.

“We had examples of children being brought in with fairly minor head injuries or after bumping their head, yet the physicians felt like they were being trapped with doing scans for these kids and they didn’t feel that was really evidence-based,” Griffin said. “They wanted to develop protocol so that we could make sure we’re only scanning the children that need to be scanned based on the evidence. By implementing a protocol around that, we were able to reduce the number of head CTs being done in the emergency room, which I would say decreased the cost of care and also improved the quality and the safety of care by not needlessly exposing children to radiation for those tests.”

One result of this ongoing transition has been an increased focus on the patient’s full experience. As online reviews play more of a role in determining a radiologist’s value, practices would do well to focus on patient satisfaction, wait times, and even the friendliness of front-desk personnel

“I think there has been an increasing emphasis on the service aspect of care delivery,” Griffin said. “If you look at [the Institute for Healthcare Improvement] and the Triple Aim, you want to have higher quality, lower costs, and improved patient experience, so understanding the role we all have in customer service for people who are seeking care is appropriate. Finding the right way to measure that, improve that, and incentive that is an important component and we all need to be a part of the discussion.”

Griffin noted that this line of thinking is a big change from how physicians were trained in the past.

“When I went to medical school, there was not as strong an emphasis as there is now on patient satisfaction,” Griffin said. “It was more of a ‘captain of the ship’ mentality, a ‘the buck stops with the physician’ mentality. As you have seen more team-based care, as we think about how we would want to be cared for by a system and we recognize that people receiving care are family members, our friends, and our communities, we recognize that there is room for improvement  from how we used to do things years ago.”

Griffin also touched on the impact these changes can have on a physician’s stress level.

“There is an increase in physician burnout and physician fatigue because of the stresses within the occupation,” Griffin said. “I would say that one of the things we face during this time, which feels like a transition, is you still have physicians who are being paid for volume. Their incentives are not aligned with this idea of focusing more for value. Any time your incentives don’t align with the messages you are being given about your profession, I think it’s stressful.”

According to Griffin, some of the stress radiologists face should decrease as everyone in the profession gets on the same page, but it won’t all get better overnight. Major changes in healthcare take a long time to play out.

As long as efforts to improve are based on collaboration, though, Griffin said the change toward value-based care should have a powerful, positive impact on patient care.

“When physicians work with everyone within healthcare, they can do more than save one life,” Griffin said. “They can save their profession, they can save their happiness, and they can practice medicine the way they always dreamt of practicing medicine before ‘the practice of medicine’ became ‘the job of medicine.’”