Surviving reform: Imagers must be proactive, involved

Cardiovascular imagers need to be proactive and involved if they want to maintain relevance in tomorrow’s healthcare systems. So advise imaging thought leaders Pamela S. Douglas, MD, and Michael H. Picard, MD, in an article in the February issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

Douglas, of the Duke Clinical Research Institute in Durham, N.C., and Picard, of Massachusetts General Hospital in Boston, authored an essay that offers cardiovascular imagers strategies for navigating healthcare reform in a period when the form of healthcare delivery remains unknown. They identified four areas that can serve as a beacon for imagers as they strive to succeed amid changes: quality; access and value; cost; and leadership.

They recommended that image technicians and physicians be familiar with and appropriately apply guidelines and standards developed by societies, accreditors and certifying organizations. Those guidelines not only address image acquisition and interpretation but also the transition to patient care and outcomes.    

“Documents such as these make clear that it is not enough to be a crackerjack imager; quality also includes the entire functioning of the laboratory and its service to patients and referring physicians,” they emphasized. “When such quality standards are followed universally, important improvements in other areas of care such as reduced downstream testing, improved correct diagnosis rate and improved health status can result.”

They encouraged imagers to be on top of the latest cardiovascular technologies and techniques, as well as health IT and meaningful use criteria. Labs should be positioned to collect and analyze data for accuracy and reproducibility and be able to tie data to outcomes.

“National trends toward professionalism and accountability are requiring imaging laboratories to pay closer attention to external determinations of quality,” they wrote. “There is every indication that adherence to such metrics will increasingly be required in the future.”

Douglas and Picard warned that imagers should expect payers to require more accreditation, certifications and licenses and will demand demonstrated proof of quality in processes and outcomes. Public reporting of statistics based on appropriate use criteria, costs, wait times and age of equipment may occur with the growing emphasis on transparency and accountability.

Imagers may need to adapt as the concept of access expands from timely delivery of service to convenient locations for referring physicians and patients, being able to provide services 24/7 and a more patient-centered approach to care that has the patient involved in decision making. That will require imagers to better educate patients about options, risks and safety in advance of tests.

Computer order systems and EHRs will be an asset. “However, unless the imaging laboratory leadership is actively engaged in contributing to the design and implementation of health information technology systems, these potential advantages may not be well articulated or prioritized, and the implementation may fall short of meeting the imaging laboratory's true needs,” they cautioned.

Imagers should strive to articulate the value and quality of their services in models, such as medical homes and accountable care organizations, and take a role in decision making. “An initial start to this process should be an evidenced-based evaluation of the role of cardiac imaging in the diagnosis and management of common cardiac diagnoses such as heart failure, valve disease and coronary artery disease,” they suggested. “Such information will be critical as cardiac imaging and its frequency are scrutinized by those determining what should be included in the typical episode of care for such diagnoses.”

To reduce costs, cardiac imaging labs should seek out purchasing partners for volume discounts and put in place protocols that reduce waste and increase throughput. The ability to prove value and remove downstream waste may be critical as bundled-payment, fixed-fee and value-based purchasing models take hold. “As physician payment models evolve, imagers should recognize that, in the future, compensation may be related to imaging quality metrics, and they should, therefore, be engaged now in defining the quality metrics by which they will be compensated; in the ever tightening healthcare economic environment, these will need to be robust,” they wrote.

The role of imagers also will change under healthcare reform. Imagers not only will be interpreters of scans but also advisers on the appropriateness and timing of scans. “CV [cardiovascular] imagers will be affected in unknown ways; however, through preparation and careful attention to the fundamentals of good healthcare (quality, access and cost) and a sense of the likely direction of many changes, imagers can be leaders in thriving now and in the future,” they concluded.