The Royal Australian and New Zealand College of Radiologists (RANZCR) relative value unit workload model, its limitations and the evolution to a safety, quality and performance framework

Abstract

The study reports on the evolution of the Australian radiologist relative value unit (RVU) model of measuring radiologist reporting workloads in teaching hospital departments, and aims to outline a way forward for the development of a broad national safety, quality and performance framework that enables value mapping, measurement and benchmarking. The Radiology International Benchmarking Project of Queensland Health provided a suitable high-level national forum where the existing Pitman-Jones RVU model was applied to contemporaneous data, and its shortcomings and potential avenues for future development were analysed. Application of the Pitman-Jones model to Queensland data and also a Victorian benchmark showed that the original recommendation of 40,000 crude RVU per full-time equivalent consultant radiologist (97-98 baseline level) has risen only moderately, to now lie around 45,000 crude RVU/full-time equivalent. Notwithstanding this, the model has a number of weaknesses and is becoming outdated, as it cannot capture newer time-consuming examinations particularly in CT. A significant re-evaluation of the value of medical imaging is required, and is now occurring. We must rethink how we measure, benchmark, display and continually improve medical imaging safety, quality and performance, throughout the imaging care cycle and beyond. It will be necessary to ensure alignment with patient needs, as well as clinical and organisational objectives. Clear recommendations for the development of an updated national reporting workload RVU system are available, and an opportunity now exists for developing a much broader national model. A more sophisticated and balanced multidimensional safety, quality and performance framework that enables measurement and benchmarking of all important elements of health-care service is needed.

What is the relation between number of sessions worked and productivity of radiologists—a pilot study?

“…A major criticism of these systems has been the lack of scoring for key activities such as interventional radiology and nuclear medicine [11,13,16]. We have included five new categories with RVU scores to update the system and increase its accuracy when assessing the workload of modern UK radiologists.…”

“…Also, our workload calculations are based on the RCSI model [13], which was in turn based on a modified PitmanJones system [16] and has not been validated in its own right. The scores for this system were originally based on time-andmotion study, but are now out of date, having been developed in 2003, and imaging studies have become more complex since then, making the weightings inaccurate [13,15,16]. Also, the case mix in Ireland and Australia are different to that of the UK, meaning that different studies are worth more to UK radiology departments, making the scoring less accurate.…”

“…We have adapted the RCSI's RVU system [13], itself based on the Pitman-Jones system [15,16] (Table 1). A major criticism of these systems has been the lack of scoring for key activities such as interventional radiology and nuclear medicine [11,13,16].…”

“…These systems are evolving but are not perfect in assigning a value to every radiology activity [11][12][13][14][15][16]. The Royal College of Surgeons and Physicians, Ireland (RCSI) devised a system which incorporates activities such as MDTs, teaching, audit and administration in net workload calculation [13].…”

Measuring radiologist workload: how to do it, and why it matters

“…The RVU assignments to different study types, and the overall method of measuring non-countable activity were based on an Australian method of workload measurement, first published by Pitman & Jones in 2006 [3], and updated in 2009 [4]. This method was chosen for the reasons that the RVUs it used (as opposed to other RVU systems used to calculate reimbursement in other jurisdictions) were a measure of radiologist activity only, without elements allowing for technologist and room costs [5] (this survey was confined to consultant radiologist activity), and that it provided a method for taking account of the growing proportion of radiologists' time which is not devoted to reporting studies.…”