October 9, 2017 (ESR, Vienna) – The ESR has recently published a concept paper on value-based radiology in response to trends in healthcare that increasingly emphasise value-based aspects in relation to quality of care, patient safety and reimbursement systems. The society and its working group on value-based imaging, established in 2016, are seeking to contribute to the discussion on this important issue and move it to the next level.
Value-based healthcare (VBH) concepts focus on ‘outcomes’ as the cornerstone for evaluating healthcare processes, cost effectiveness and healthcare professionals’ performance. What has been lacking so far is the inclusion of the diagnostic process, which constitutes the integral first part of every care cycle. The ESR argues that the diagnosis should be recognised as the first ‘outcome’ for patients.
“Within existing VBH frameworks, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists’ diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts”, Professor Lorenzo Derchi, chair of the ESR Value-Based Imaging Working Group and ESR 1st Vice-President, sums up the main message of the paper.
The ESR has long fully identified with the quality imperative of providing the best possible patient care in any circumstance. The budgetary constraints in many health systems in recent years have given the need to re-evaluate healthcare delivery a new urgency, and value-based approaches have rapidly been gaining currency. From a radiology point of view, the biggest concern is that the measurement of health outcomes starts at a point where most of the radiologists’ and other diagnosticians’ work has already happened. Not only has no radiologist been involved in the creation of the current framework nor is radiology as a whole considered in value-based healthcare concepts; the diagnosis is taken for granted. Current value measurement is based on a three-tier model comprised of sustainability of health, process of recovery and health status achieved or retained. So far, the diagnostic progress is only considered in the second tier, and even then solely as having a negative effect on outcomes in case of any errors or complications.
Derchi points out the fundamental flaw in the current framework: “Radiologists’ work is key to the diagnostic process of modern healthcare delivery and therefore the establishment of a correct diagnosis is the first outcome that must be considered in the healthcare process. I would also like to point out that great benefit to patients comes from the exclusion of significant disease and that none of these outcomes is being reflected or even taken into consideration in any of the current value-based healthcare models.”