Vet­ting the qual­ity of imag­ing ser­vices

Modern Healthcare - - INNOVATIONS - By Beth Kutscher

Health­care price trans­parency is slowly gain­ing ground as em­ploy­ers be­come more cost con­scious, and con­sumers have to pay more out of pocket un­der high-de­ductible health plans. But a key miss­ing link has been the abil­ity of em­ploy­ers and con­sumers to ob­tain re­li­able in­for­ma­tion about qual­ity as well as price.

Re­view sites have pro­lif­er­ated, but the rat­ings fo­cus on fac­tors such as cus­tomer ser­vice and wait times, rather than clin­i­cal qual­ity and out­comes.

New York City-based Spre­emo started in 2010, with a fo­cus on help­ing em­ploy­ers and pa­tients vet di­ag­nos­tic imag­ing cen­ters on qual­ity and price. Ra­di­ol­ogy is a spe­cialty where many con­sumers are able and will­ing to com­par­i­son shop.

As an ex­per­i­ment, Ron Vianu, co-founder and CEO of Spre­emo, sent his mother, who had lower back prob­lems, to three mag­netic res­o­nance imag­ing cen­ters in New York City. She un­der­went three scans and re­ceived three dif­fer­ent rec­om­men­da­tions and treat­ment plans. “Most peo­ple think ra­di­ol­ogy is a com­mod­ity,” Vianu said. But, he added, “there’s very lit­tle con­sen­sus about what goes into qual­ity.”

Spre­emo has de­vel­oped soft­ware that helps con­sumers eval­u­ate qual­ity and costs. It col­lects ex­ten­sive data from providers, from their ac­cred­i­ta­tion to their pro­to­cols, such as how many pic­tures they take per scan. The com­pany grades imag­ing cen­ters based on how ac­cu­rately they in­ter­pret scans, the types of equip­ment they use, and their turn­around time.

It has even launched its own Qual­ity Re­search In­sti­tute that asks out­side ex­perts to de­velop con­sen­sus on what con­sti­tutes qual­ity and to mea­sure the im­pact on pa­tient out­comes. The ex­perts reg­u­larly re­view a ran­dom sam­ple of scans from Spre­emo’s providers to com­ple­ment the com­pany’s pre­dic­tive mod­el­ing, with the idea that high-qual­ity cen­ters should have the least de­gree of vari­abil­ity. Spre­emo’s se­nior med­i­cal ad­viser, Dr. Richard Her­zog, who di­rects spinal imag­ing at New York’s Hos­pi­tal for Spe­cial Surgery, heads the re­search in­sti­tute.

Spre­emo’s cur­rent fo­cus is on work­site in­juries. Its main client base is large, self­in­sured em­ploy­ers and worker-com­pen­sa­tion in­sur­ers. “Em­ploy­ers are very in­cen­tivized to get peo­ple bet­ter,” Vianu said. “If some­one has less than op­ti­mal care, that’s go­ing to cost them.”

Providers that want to join Spre­emo’s re­fer­ral net- work send their data to the com­pany. Em­ploy­ers and third-party ad­min­is­tra­tors use the data to match pa­tients to imag­ing cen­ters. The data are sortable by qual­ity met­rics, price and travel dis­tance to the listed cen­ters.

Ra­di­ol­ogy ser­vices have be­come price trans­par­ent at a faster rate than other med­i­cal spe­cial­ties, ac­cord­ing to a study in the Jour­nal of the Amer­i­can Col­lege of Ra­di­ol­ogy pub­lished in April. Re­searchers found that nearly 80% of aca­demic med­i­cal cen­ters and pri­vate ra­di­ol­ogy prac­tices were able to pro­vide prices for a head CT scan with­out a con­trast agent. Rates ranged from $211 to more than $2,000.

Ra­di­ol­ogy re­sults can vary based on the type of equip­ment used, the soft­ware up­grades made and clin­i­cian skill, said Dr. Robert Ep­stein, chair­man of Univer­sity Ra­di­ol­ogy Group, which has 20 of­fices in cen­tral New Jer­sey. “Part of qual­ity is good tech­nol­ogy,” he said. “It’s really about the ma­chine, the soft­ware, the process and the ra­di­ol­o­gists.”

Ep­stein’s group, which joined Spre­emo’s re­fer­ral net­work three years ago, said Spre­emo’s fo­cus on value en­cour­ages ra­di­ol­ogy groups to in­vest in high-qual­ity equip­ment. “They stand out be­cause they are more in tune with our fo­cus on qual­ity and value, and less so on ab­so­lute price,” Ep­stein said. The re­la­tion­ship also has helped con­nect the group with large em­ploy­ers.

Ep­stein said many pay­ers steer pa­tients to the low­est-cost provider. But poor-qual­ity imag­ing can end up cost­ing more and pro­duc­ing a bad out­come. “If you save $100 or $200 on an MRI, but you have an un­nec­es­sary $50,000 back fu­sion, that’s ac­tu­ally not so good for pa­tients,” he said.

Spre­emo re­cently sur­passed 100 employees, and in June se­cured an in­vest­ment from pri­vate-eq­uity firm Pam­plona Cap­i­tal Man­age­ment, whose size was not dis­closed. Vianu said it has providers in ev­ery state.

Look­ing ahead, the com­pany sees an op­por­tu­nity to pro­vide pay­ers and pa­tients with the same type of as­sis­tance for other med­i­cal-spe­cialty ser­vices. It also en­vi­sions mar­ket­ing its soft­ware to or­ga­ni­za­tions that are work­ing un­der fi­nan­cial-risk con­tracts tied to pa­tient out­comes.

Pay­ers and con­sumers need to be able to understand what they’re buy­ing, Vianu said. “You want to go to some­one who gets you bet­ter.”

“Most peo­ple think ra­di­ol­ogy is a com­mod­ity. There’s very lit­tle con­sen­sus about what goes into qual­ity.” RON VIANU

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