The radiology specialty, like other healthcare practices, is being transformed from a volume-based model to a value-based model. In Kansas, Wichita Radiological Group, one of the largest subspecialty-focused groups in the state, is embracing that change wholeheartedly.
Kamran Ali, MD, FACR, President, Wichita Radiological Group
“The big focus for years within radiology was volume — ordering imaging and sitting in a dark room and interpreting those images,” says Kamran Ali, MD, a radiologist who serves as President of WRG. “It was like a factory, a stack of exams would be generated and the radiologists would pull them off the line and read them. Medicine has evolved with imaging at the center of the diagnostic enterprise. We are physicians, and we want to engage in the patient’s overall health. We want to be a doctor’s doctor and go beyond ordering and reading images. Our goal is to become more integrated with patient care.”
WRG has been one of the early adopters of value-based care in the field of radiology. In a recent interview with the online publication Diagnostic Imaging, Ezequiel Silva III, MD, Chair of the American College of Radiology Commission on Economics, said that the movement to value-based care in radiology is moving slower than expected.
But that has not been the case with WRG. In fact, WRG received a commendation from the American College of Radiology as a model for transforming to a value-based system, Dr. Ali says.
Dr. Chris Baalmann
Some of the movement to a value-based system has come about because of regulation, policy and payment changes on state and federal government levels, such as the Medicare Access and CHIP Reauthorization Act (MACRA) and the Protecting Access to Medicare Act. The latter, which will go into effect Jan. 1, 2020, requires referring providers to consult appropriate use criteria when ordering advanced diagnostic imaging services to avoid unnecessary imaging for patients.
A crucial factor for a practice to make such a switch, however, comes from within — from the physicians who want to help enhance the patient’s healthcare experience, which has been the case at WRG, Dr. Ali says.
Dr. Ali credits his colleagues in the group as helping make the value-based transformation a reality.
“We have a culture in this organization that supports this change,” he says.
Wesley CT Tech Kham Nola
Many in the group see the value-based model as being more responsive to patient needs, enhancing partnerships with referring providers and helping with the practice’s workflow and efficiencies, Dr. Ali says.
Twenty-four physicians — 20 radiologists, three radiation oncologists and one sleep medicine physician — and three physician assistants comprise the medical staff at WRG, founded in 1952.
The practice is the only one in Kansas outside of the Kansas City area that provides a diagnostic radiology residency, says Dr. Ali, who has served as WRG’s Residency Program Director since 2008. It accepts three residents each year for its residency program, many of whom return to the state after fellowship to practice.
Patient experience and safety — other features in a value-based system — are important to WRG medical staff, and that’s reflected on several fronts. Several of the group’s physicians participate on national healthcare boards and hospital committees. It has continued to invest in imaging technology and treatments along with training, and it has expanded its services over the years, including the addition of a mobile imaging service that can provide bedside imaging in long-term nursing facilities.
“We are well aware of the public’s and payer’s concerns about unnecessary examinations and any risks that might be associated with the use of radiation. We strive to provide appropriate, necessary examinations and treatment options that minimize the risks to the patient and help ensure achieving an answer and appropriate outcomes for the patient in the quickest, most cost-effective manner,” Dr. Ali says.
By being involved with boards and committees, WRG physicians stay engaged and network with other medical professionals to ensure better patient care. WRG’s Medical Director Akash C. Joshi, MD, for example, serves on the Wesley Medical Center medical executive committee, while John H. Lohnes Jr., MD, serves on the board for an independent physician specialty group (SIPAK), the initial MACRA MIPS committee for the American College of Radiology and as the radiology representative for the medical advisory board for Blue Cross Blue Shield of Kansas. The group also is routinely called upon by insurers regarding imaging coverage decisions.
In the realm of advancing technologies and treatments, WRG — through its Cypress Imaging division, is the region’s leading provider of 3D mammography, also known as digital breast tomosynthesis, that has become a game-changer in early breast cancer screening. 3D mammography captures finer, detailed images of the breast using a low dose of radiation.
In 2003, WRG started its Cypress Women’s Imaging division to offer more comprehensive women’s health imaging and outpatient services. Over the years, that division expanded to become Cypress Imaging; now, six locations in Wichita provide not only imaging for women’s health care but also traditional imaging such as CT and MRI. WRG, through all of its Cypress facilities and other partnerships, conducts as many as 450,000 studies a year, according to WRG Executive Director Raedina Campbell.
Over the past several years, WRG has reinvigorated its interventional and treatment activities. Expansion of its radiation oncology services and utilization of higher energy and more accurately targeted delivery means fewer side effects and shorter courses of treatment. In the interventional realm, it also has started providing high-energy, pinpointed catheter directed chemo and radiation therapy to treat liver cancer.
Dr. Akash Joshi
Based on patient satisfaction outcomes with its Cypress Women’s Imaging model, Dr. Ali says, WRG decided to apply the same model of offering extended outpatient services with its interventional division.
In August, WRG will open its Cypress Interventional division, located in the same building as its Cypress Imaging East location at 9300 E. 29th St. in Wichita. With more than 2,000 square feet, the new location will provide interventional outpatient procedures such as paracentesis, kyphoplasty, vascular access, renal access, vein ablation and IVC filter placement and retrieval, Dr. Ali says. A longitudinal care platform will be an important component of this therapy service, where patients undergoing procedures will have pre-procedure consultations and subsequent clinical follow up in our interventional clinic, keeping in line with our value based model.
Wichita Radiological Group physicians
Another of WRG’s successful divisions is Kansas Mobile Solutions, which brings imaging services 24/7 directly to a patient’s bedside in long-term senior care facilities throughout Kansas communities. With its 14-fleet concierge care service, Kansas Mobile Solutions offers portable X-rays, EKGs and ultrasound services, along with vascular access services.
Patient comfort and safety are enhanced with the mobile concierge service as the patient does not need to be moved from the care facility and treatment won’t be delayed, Dr. Ali notes. Plus the on-site service results in a lower charge to Medicare, helping save the system money. It also has been used by some rural hospitals to expand their service lines and improve turnaround times on reports, helping them to remain viable alternatives for their communities.