27 Jan Primary Care Physicians Believe Advanced Radiology Imaging Important For Patient Care
Medical Research: What is the background for this study?
Response: Value in healthcare is a popular topic today. Yet no clear value measures have been developed which could be used in policy decisions on reimbursement for diagnostic imaging procedures. Within the imaging sector it is a given that imaging has value. However efforts to articulate that value to payers and policy makers and others outside the sector have come up short. We did conduct qualitative research with radiologists but during this process of mapping a value chain it became clear that those M.D.s who use the data that radiology provides to make decisions on patient care could better speak to imaging’s value. And primary care because of the gatekeeper status for all types of care seemed appropriate.
Medical Research: What are the main findings?
Response: Primary care physicians highly value access to advanced imaging: 88% of the PCPs indicated that advanced imaging increases their diagnostic confidence; 90% believe imaging provides data not otherwise available; 88% reported access to imaging permits better clinical decision making; 88% reported increases confidence in treatment choices , and 86% say it shortens time to definitive diagnosis. Most Primary care physicians ( 85%) believe that patient care would be negatively impacted without access to advanced imaging.
One very interesting finding is in differences in attitudes and valuations in younger vs. older physicians towards advanced imaging modalities. For the purposes of this part of the analysis we divided the survey respondents into those in practice 1-20 years and those practicing radiology more than 21 years. Presumably those practicing less 21 years trained with ready access to advanced imaging versus those who presumably having practiced without ready access to the advanced imaging modalities of MRI, CT and PET. Respondents who have practiced without ready access attach higher value to the ability to shorten the time to definitive diagnosis, ability to replace invasive procedures, make better clinical decisions, and believe the quality of patient care would be negatively impacted without access to advanced imaging. The younger physicians attach more value to the practice efficiency issues such as enabling the Primary care physician to see more patients, or patient centric issues like the ability to communicate on a visual level with the patient.
Medical Research: What should clinicians and patients take away from your report?
Response: Advanced Imaging Modalities (AIM) such as CT, MRI, and PET have been the target of cost costing measures by payers. Some of the emphasis is short sighted because due to its focus on the cost of the procedures rather than the changes in the clinical pathways with imaging. One example would its ability to replace a percentage of invasive procedures in the areas of myleograms, exploratory laps, and diagnostic arthroscopies.
Perhaps the data can be used to educate payers and Primary care physicians about the value of imaging. This paper is a great conversation starter between the radiologist and the PCP. Letting the Primary care physician know where their peers are at with advanced imaging. There is a great deal of downward pressure on the Primary care physician to monitor their use of advanced imaging and consequently confusion over what tests are appropriate and when. The message to consumers, Primary care physicians, payers and policy makers is – Advanced imaging (CT, MRI, PET) leads to better patient outcomes.
Also the pricing transparency issue is important – this should be a priority message for radiology groups to their referring physicians and the general public to combat the misrepresentation that imaging costs are what’s wrong with the system. The Primary care physicians believed that Medicare pays nearly 3x more for an MRI than it does yet they still attach high value at 3x the actual cost. This data point dovetails with our consumer research indicating that consumers also over estimate the reimbursement levels by about 300% for MRI.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Comparative effectiveness research for diagnostic imaging can be complicated for a variety of reasons including its role is limited to diagnostics rather than therapeutics. Consequently, we should look to other ways to establish value metrics such this type of study among specialists and better understanding the economic impact on clinical pathways imaging technologies make.
Christine M. Hughes, Erich Kramer, Jennifer Colamonico, Richard Duszak
Publication stage: In Press Corrected Proof
Journal of the American College of Radiology