The 21st-century radiology department: lessons from the pediatric section

Abstract

Health care policy in the USA is in a time of transition. The requisite changes will impact services and practices throughout provider systems. Radiology departments will not be spared from these changes and will be forced to meet shifting expectations. Many of the standard practices within pediatric radiology sections can be utilized in a broader context throughout radiology departments as they evolve to meet these novel challenges.Even before the Supreme Court decision upholding the Patient Protection and Affordable Care Act (PPACA), accountable care organizations (ACOs) were being established across the USA [1]. The ACOs, or networks of hospitals, patients and caregivers, are an integral part of the developing health care system. The goal of ACOs is to provide better care for patients while simultaneously lowering overall costs. By focusing on outcomes and holding health care providers accountable, the belief is that patient care will be better coordinated and less expensive while generating improved outcomes.Although the current U.S. health care system is focused on providing the highest level of care, for at least a portion of the population, it does so at an enormous cost. In 2010, it is estimated that health care expenditure was $2.6 trillion, or 17.9% of the GDP [2]. One of the main drivers of health care expense is medical imaging [3]. Although there have been recent declines in medical imaging, it still represents more than 9% of overall Medicare spending [4]. For there to be meaningful reductions in the health care expenditure, there will need to be controls on the relative amounts spent on radiology and radiology services.Although it is not clear exactly how ACOs will best address medical imaging, what is understood is that radiology will have an important role in achieving the required efficiencies and optimizing patient care. While clinicians will be incentivized through their shared savings programs to limit the overall number of examinations ordered, radiology has the potential to make diagnoses faster, allowing earlier treatment and the hope of better patient outcomes, so it will continue to have a central role in care. There should also be cost savings related to making a more timely diagnosis, including expenses related to time spent in the hospital undergoing observation as well as additional tests.It has been noted that radiologists are more than simply skilled examination interpreters [5][6][7]. In a general sense, there are two categories of value that radiologists provide: interpretive and non-interpretive. Interpretive value is based on the review and reporting of medical imaging examinations. This is the value provided by "reading films." Typical metrics of interpretive value focus on speed of interpretation (as measured by turn-around times of reports) and accuracy (as measured by various quality-assurance parameters). Non-interpretive value refers to the other duties that radiologists perform, including time spent consulting with clinicians, speaking with patients and families, attend...