As evidence-based medicine (EBM) evolved into value-based medicine (VBM) — the "practice of medicine based upon the patient-perceived value conferred by an intervention," as Jong-Myon Bae defined it in the journal Epidemiology and Health — many referring physicians began to wonder about their choice of imaging providers.
Hospital-affiliated doctors can simply send a patient to the basement for an MRI or an ultrasound. But does this practice really contribute to a patient-centered model of care like VBM? Could physicians attain reliable diagnostic imaging at a reduced price for their patients, thereby balancing the outcome-to-cost ratio?
The answer is, resoundingly, yes. The reason? Independent imaging centers.
The price of an MRI at a freestanding clinic is often thousands of dollars less than the same scan, with the same outcomes, performed at a hospital. There are a few reasons for this — hospitals subsidize revenue-losing departments through radiology, and they're less vulnerable to market-driven competition — but suffice it to say, freestanding imaging centers provide the same service as hospitals at a fraction of the price.
In August of 2016, the European Society of Radiology's Working Group on Value-Based Imaging began its work investigating how radiology could better take part in the VBM model of patient care. Among the Working Group's findings:
- The VBM model, as currently practiced, leaves diagnostic imaging out of the equation. Practitioners measure the success of value-based outcomes starting with treatment — which, notably, cannot begin until the radiologist has completed her role in an accurate diagnosis.
- In fact, a traditional VBM approach only factors in diagnosis when it is incorrect, or when it causes complications. This bias neglects the value a patient places in a correct diagnosis, which is, the first in a string of health outcomes that truly matters to the patient and his family.
- In order to fold radiology the VBM paradigm, imaging providers should measure and improve five process steps in their work: Determining whether the referral is appropriate, protecting patients from radiation, producing radiology reports that are entirely accurate and easy to understand, maintaining excellent relationships between patients and the provider's entire staff, and continuing education and innovation in the field.
Regarding that last point — arguably the Working Group's greatest revelation — note that freestanding imaging providers are often at the forefront of these five process steps. In a marketplace glutted with competition, no imaging provider can afford to fall behind in the quality of care they offer patients. And, as previously noted, freestanding imaging centers offer this care at a much lower price-point than traditional hospital-based radiology departments. Often, they employ the exact same radiologists as the hospitals, and operate identical equipment.
A true reckoning of value-based medicine starts with making the right diagnosis, and that often depends on great radiology. Independent imaging centers offer that level of quality at a lower price. Therefore, they are valuable partners in value-based care.
If you're a referring physician, the patient-centered approach is to talk to patients about their choice of diagnostic imaging providers. Often, the freestanding clinic leads to better outcome-to-cost ratios, which lie at the heart of value-based medicine.