The European Society of Radiology (ESR) has released a concept paper on value-based radiology (VBR), arguing for greater inclusion of diagnostics for radiology and other medical areas in value-based health care (VBH).

The paper argues that the VBH model disregards the diagnostic process when evaluating quality of care for patients, and that diagnosis should be the first outcome assessed in regard to this matter. The findings in the paper were compiled by ESR and its Value-Based Imaging Working Group (VBI WG).

“Patients benefit from a timely and accurate diagnosis, which is the basis for any treatment decision,” Professor Lorenzo Derchi, the first vice-president of ESR and the chair of the VBI WG, told HCB News. “By changing the incentives in the diagnostic process from volume-based toward value-based aspects, radiology departments will focus more on what effect their work has and what matters most to patients, rather than on the number of exams and reports they produce.”

The paper’s publication comes at a time in which health care and radiology trends are shifting from volume- to value-based systems that focus more on quality of care and patient safety as well as reimbursement systems instead of the number of services carried out.

ESR and VBI WG argue that the concept of VBH is flawed by the fact that health outcomes are only considered once diagnostics have been completed, and because no radiologist has been involved in construction of the VBH concept. It also notes that radiology as a whole is not even considered in the three-tier model, the second of which focuses only on the diagnostic process in regard to errors and complications that take place.

The paper asserts that diagnosis should be the first outcome considered, as it is the first step for determining the best course of action in treating a patient and lays out a series of metrics for measuring the quality of radiologists’ diagnoses and how they apply value to patients, medical specialists, and health care systems.

Areas in which these metrics should apply, according to the paper, include appropriateness of requests, attention to radiation protection measures, characteristics of reports, patient and radiology personnel relationships, and continuous professional education, research and innovation.

Derchi says diagnosis is largely taken for granted as a simple and reproducible process. He also claims that factors, such as VBH being relatively new and in need of maturity, and the greater ease in measuring treatment outcomes than those in diagnostics, have also contributed to its exclusion in VBH.

“The discussion on value-based radiology is incipient, especially in Europe, and so far has mostly taken place within the radiology community,” he said. “While that is no doubt important, we also need to start engaging external stakeholders. We are not simply publishing a paper and waiting for VBH advocates to take up our ideas. We are very much planning to be an active partner in this discussion.”

The paper was published in Insights into Imaging.

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