Masters of Radiology Panel Discussion: Models for Health Care Performance in Radiology—How Do We Measure Our Productivity and Ourselves?

Abstract

M. C. Javitt is an unpaid consultant to Code Ryte and her husband owns stock in Code Ryte. D. B. Larson is a case contributor to Amirsys and is reimbursed on a contract basis. INTRODUCTION. Each quarter, the AJR will publish the transcripts of the Masters of Radiology panel discussion hosted by Dr. Howard P. Forman and Dr. Marcia C. Javitt. The panel will review topics of importance to the field of radiology and share their unique insight into how these issues are shaping or will shape the future of the specialty. Forman: Measuring performance and productivity ties into many issues that are very current for radiology. One concern is how these measurements relate to the maintenance of certification (MOC) process and even the whole method of residency training and initial board certification. A second question involves how payment is linked to productivity. For example, how do we, within both private and academic practices, compensate and measure productivity? Third, we need to think about how we can measure the best in our health care performance and delivery in a time when we’re thinking more about accountable care organizations and about integrating radiology into the health care enterprise, as opposed to encouraging us to be an independently operated, standalone entity. Norbash: I don’t believe that unilateral determinations of productivity and reward systems generated by a chair have an enduring, positive influence, especially when contrasted with mutually agreed targets. A similar challenge is in determining the degree of autonomy given to individuals and sections versus the amount of central control necessary at the departmental and institutional levels. As our margins decrease, as our subsidy basis becomes challenged, and as we have to look at whether we have to cross-subsidize from our technical revenue to professional revenue to sustain departments, it becomes clear that the discussion is becoming more intense and more direct. Specifically, institutions and departments are becoming progressively more interested in describing and measuring the total amount of work that each person does. Many of the Masters of Radiology panel members have come up with complicated, formulaic systems that are very elegant and detailed and look at an individual’s contributions, including administrative, academic, teaching, and work contributions. We’ve also seen a number of complex formulas from outside of this group. One of these comprehensive formulas was beautifully done by Reuben S. Mezrich’s group at the University of Maryland Medical Center in Baltimore. In addition, there is a spectrum of work output, whether considering the departmental or individual benefits gained. When you look at a radiologist’s work, much of the academic output is not simply to the department’s benefit; much of the academic and research accomplishments can simultaneously be seen as self-promotional. On the other hand, much of the interdisciplinary conference and uncompensated consulting contributions within the hospital are directed at community benefit. As such, a radiologist who spends a considerable amount of time being consulted and pulled into conferences may not sympathize with the additional time granted to teachers and investigators for their pursuits, even though the collective contributions are fundamental to the functions of an academic department. Moving away from what’s self-serving, social service and institutional educational activities are very valuable. But, it’s challenging to come up with credible ways of reliably measuring the different performance indicators and assembling them to realize the total value of an individual’s contributions in a metric way. Part of the reason for this conversation on metrics is because we’re being called to task for our current accounting methods to show the value of radiologists to the organization and the institution. To date, our charge has been to generate more revenue, do more studies, and Forman et al. Masters of Radiology Panel Discussion