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Pediatric Radiology

, Volume 47, Issue 7, pp 776–782 | Cite as

Quality measures and pediatric radiology: suggestions for the transition to value-based payment

  • Richard E. HellerIIIEmail author
  • Brian D. Coley
  • Stephen F. Simoneaux
  • Daniel J. Podberesky
  • Marta Hernanz-Schulman
  • Richard L. Robertson
  • Lane F. Donnelly
Minisymposium: Quality and clinical practice management

Abstract

Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.

Keywords

Measures Metrics Pay-for-performance Pediatric radiology Quality Value 

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Centers for Medicare & Medicaid Services (2015) The Medicare Access and CHIP Reauthorization Act of 2015: path to value. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf. Accessed 5 November 2016
  2. 2.
    Burwell S (2015) Setting value-based payment goals. N Engl J Med 372:897–899CrossRefPubMedGoogle Scholar
  3. 3.
    Donnelly LF, Gessner KE, Dickerson JM et al (2010) Department scorecard: a tool to help drive imaging care delivery performance. Radiographics 30:2029–2038CrossRefPubMedGoogle Scholar
  4. 4.
    Hughes D (2017) Radiologists and CMS’ patient facing designation. http://www.neimanhpi.org/commentary/radiologists-and-cms-patient-facing-designation/. Accessed 22 February 2017
  5. 5.
    Clemens J, Gottlieb JD (2013) In the shadow of a giant: Medicare’s influence of private physician payments. Working paper 19503. National Bureau of Economic Research. http://www.nber.org/papers/w19503.pdf. Accessed 5 November 2016
  6. 6.
    Paradise J (2015) Medicaid moving forward. The Henry J. Kaiser Family Foundation. http://kff.org/health-reform/issue-brief/medicaid-moving-forward/. Accessed 5 November 2016
  7. 7.
    Heller RE (2016) An analysis of quality measures in diagnostic radiology with suggestions for further advancement. J Am Coll Radiol 10:1182–1187CrossRefGoogle Scholar
  8. 8.
    Chassin MR, Loeb JM, Schmaltz SP, Wachter RM (2010) Accountability measures — using measurement to promote quality improvement. N Engl J Med 363:683–688Google Scholar
  9. 9.
    Narrayan A, Cinelli C, Carrino JA et al (2015) Quality measures in radiology: a systematic review of the literature and survey of radiology benefit management groups. J Am Coll Radiol 12:1173–1181CrossRefGoogle Scholar
  10. 10.
    Donabedian A (1988) The quality of care. How can it be assessed? JAMA 260:1743–1748CrossRefPubMedGoogle Scholar
  11. 11.
    Larson DB, Towbin AJ, Pryor RM, Donnelly LF (2013) Improving consistency in radiology reporting through the use of department-wide standardized structured reporting. Radiology 267:240–250CrossRefPubMedGoogle Scholar
  12. 12.
    De Lorijn F, Reitsma JB, Voskuijl WP et al (2005) Diagnosis of Hirschsprung’s disease: a prospective, comparative accuracy study of common tests. J Pediatr 146:787–792CrossRefPubMedGoogle Scholar
  13. 13.
    Darling S, Sammer M, Chapman T, Parisi MT (2011) Physician documentation of fluoroscopy time in voiding cystourethrography reports correlates with lower fluoroscopy times: a surrogate marker of patient radiation exposure. AJR Am J Roentgenol 196:W777–W780CrossRefPubMedGoogle Scholar
  14. 14.
    Agency for Healthcare Research and Quality (2016) The CAHPS child hospital survey. http://www.ahrq.gov/cahps/surveys-guidance/hospital/about/child_hp_survey.html. Accessed 20 November 2016
  15. 15.
    Toomey SL, Zaslavsky AM, Elliott MN et al (2015) The development of a pediatric inpatient experience of care measure: child HCAHPS. Pediatrics 136:360–369CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Rice S (2013) How a hospital’s chief experience officer tackles barriers to better quality. http://www.modernhealthcare.com/article/20141213/MAGAZINE/312139987. Accessed 8 November 2016
  17. 17.
    Dickerson EC, Alam HB, Brown RK et al (2016) In-person communication between radiologists and acute care surgeons leads to significant alterations in surgical decision making. J Am Coll Radiol 13:943–949CrossRefPubMedGoogle Scholar
  18. 18.
    DeVoe J, Fryer GE Jr, Hargraves JL et al (2002) Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? J Fam Pract 51:223–228PubMedGoogle Scholar
  19. 19.
    Schuster MA (2015) Measuring quality of pediatric care: where we’ve been and where we’re going. Pediatrics 135:748–751CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Richard E. HellerIII
    • 1
    Email author
  • Brian D. Coley
    • 2
  • Stephen F. Simoneaux
    • 3
  • Daniel J. Podberesky
    • 4
  • Marta Hernanz-Schulman
    • 5
  • Richard L. Robertson
    • 6
  • Lane F. Donnelly
    • 7
  1. 1.Radiology PartnersEl SegundoUSA
  2. 2.Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical CenterUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of Radiology, Children’s Healthcare of AtlantaEmory University School of MedicineAtlantaUSA
  4. 4.Department of Radiology, Nemours Children’s Health SystemNemours Children’s HospitalOrlandoUSA
  5. 5.Department of Radiology, Monroe Carell Jr. Children’s Hospital at VanderbiltVanderbilt University School of MedicineNashvilleUSA
  6. 6.Department of Radiology, Boston Children’s HospitalHarvard Medical SchoolBostonUSA
  7. 7.Department of RadiologyTexas Children’s Hospital HoustonUSA

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