By Kent Spafford, Company Advisor and Board Member, One Call
The U.S. Healthcare market employs approximately 950,000 physicians today. In developing the appropriate treatment plan for their patients, these physicians routinely request diagnostic imaging for their patients, which now accounts for $100 billion dollars in healthcare spend annually according to American College of Radiology statistics1. This is a big number and through strategic partnerships with diagnostic networks, the workers’ compensation industry can work to decrease costly and unnecessary diagnostic testing.
Workers’ compensation carriers spend considerable time and resources developing high quality physician networks to drive optimal outcomes while minimizing unnecessary utilization. It is our belief that these physicians are thoroughly vetted based on their medical credentials and performance, and that they represent the preferences of the payers who contract with them.
A good diagnostic provider network should provide easy access to accredited centers, state of the art equipment, high-tesla magnets, board certified radiologists and timely results. A comprehensive understanding of how each testing facility fits within that network and their individual competencies leads to better patient placement. While most diagnostic provider networks have their own way of addressing this differentiation, they commonly fall short in managing physician discernment and confidence in the results.
The need for physician support and partnership cannot be understated when considering both pre and post-exam requirements. Regardless of diagnostic quality, if the physician does not have the necessary results required to diagnose and treat, patient care is at a standstill.
Diagnostic provider networks in the workers’ compensation arena are expected to be partners in patient care. The industry has become increasingly conscientious of cost, quality and utilization and is holding its’ partners to higher standards. Diagnostic network partners should offer active management of patient scheduling to drive penetration, improve completion percentage and provide a better user experience. Understanding patient and physician needs will help identify the best facility for that specific case. Just because a facility is deemed high quality does not mean they are the best choice for every patient.
Pre-screening the patient is the first opportunity to understand any special circumstances of a given case. This information helps validate patient demographics while trying to match their needs with an appropriately suited diagnostic provider. This process, although simple, can dynamically change how a patient is scheduled.
Some examples of pre-screening questions should include:
- “Did you have previous surgery to the area?” – If yes and the ordered test is a lumbar spine MRI, one would need to ensure the prescription covers both with and without contrast for the most appropriate imaging.
- “Do you grind or work with metals?” – If yes, the patient may need to be scheduled at a center capable of orbital screenings to ensure there is no metal in the patient’s eyes prior to placing the patient inside a powerful magnet.
- “What is your height and weight, and are you claustrophobic?” – If the patient is wide and tall or claustrophobic, considerations should be made to put them in either a wide bore or open MRI machine.
Taking this information into account while considering patient needs, physician requirements and diagnostic center competencies will help with placement at the most appropriate diagnostic provider. After the testing provider is selected, the diagnostic network partner should turn its attention back to the physician to determine how the results will be utilized.
- Is the requesting physician an orthopedic surgeon who will rely heavily on the images and use the medical report as a guide?
- Is the physician a specialist looking to understand how successful a previous surgery was?
- Is this a primary care physician relying on the medical report to determine if a specialist is warranted?
Creating open dialogue with these physician groups and understanding their needs allows for consistency in diagnostic results. More importantly, validating the physician’s purpose for the exam can help to ensure all necessary documentation is supplied back to their office in the most efficient way possible.
A completed exam and submission of the medical report is the minimum expectation for diagnostic provider network’s involvement. Oversight of the testing results, although not required, is essential in providing accurate outcomes. If the wrong body part is scanned, the wrong test completed, or if the patient’s name is incorrect on the report your diagnostic partner should be capable of resolving these issues through their quality assurance process. This simple step can help to avoid physician confusion as well as expensive and time-consuming issues down the road.
A majority of the time however, things do go according to plan: the patient uses the most appropriate center, the correct test is performed and the image quality and report are crystal clear. However, even in the best-case scenario, a treating physician could have clinical concerns on test findings or questions on interpretation due to clinical correlation between exam and injury, requiring a second opinion by a board-certified radiologist to provide additional clarity around the injury.
Regardless of the findings, efficient delivery of test results to the treating physician is vital to eliminate claim stagnation and allow the patient to continue their established momentum. The heavily relied upon process of hand-carried CDs for medical image delivery is antiquated and inconsistent as patients often forget to bring them to follow-up appointments. Technology-based solutions that leverage cloud-based storage and PACS connectivity create a direct bridge between the diagnostic network partner and the service provider and offers secure access for the physician’s office.
These connections also have the potential to fully integrate with electronic health record (EHR) systems and provide seamless transmission of testing results. A strong diagnostic network partner will invest time and capital in these resources as they are key in providing physicians with convenient access to critical data.
In the end, regardless of quality, if the doctor is not confident in the testing results, the patient’s treatment will come to a halt. A strategic and tactical partnership with your diagnostic provider network is a way to mitigate risks and ensure continuity of care for your patients. All diagnostic networks provide images and medical reports, but a true diagnostic partner is invested in patient care and delivery of exceptional results.
About Kent Spafford
Kent Spafford has been Company Advisory and Board Member at One Call since 2013. Kent previously served as the CEO and President of One Call.
About One Call
Headquartered in Jacksonville, Florida, One Call is the nation’s leading provider of specialized healthcare solutions for the workers’ compensation industry. One Call arranges convenient, efficient and cost-effective healthcare for injured workers so they can get back to work and life faster. From diagnostics and medical equipment to home healthcare, physical therapy and transportation, One Call offers a complete suite of innovative products and services with a focus on injured workers’ needs across the continuum of care. For more information and the latest news, visit us at onecallcm.com, LinkedIn (One Call) and Twitter (@onecallcm).
1Vreeland, A., Persons, K.R., Primo, H.. et al. J Digit Imaging (2016) 29: 547. https://doi.org/10.1007/s10278-016-9885-x
One Call is a WorkCompWire ad partner.
This is not a paid placement.