Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations

Khushboo Jhala; Elyse A Lynch; Sunil Eappen; Patrick Curley; Sonali P Desai; James Brink; Ramin Khorasani; Neena Kapoor

doi:10.1016/j.jacr.2023.12.016

Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations

J Am Coll Radiol. 2023 Dec 24:S1546-1440(23)01035-9. doi: 10.1016/j.jacr.2023.12.016. Online ahead of print.

Authors

Khushboo Jhala¹, Elyse A Lynch¹, Sunil Eappen², Patrick Curley³, Sonali P Desai⁴, James Brink⁵, Ramin Khorasani⁶, Neena Kapoor⁷

Affiliations

¹ Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
² Senior Vice President of Medical Affairs, Chief Medical Officer, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
³ Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Executive Director, Quality and Safety, Enterprise Radiology, Mass General Brigham.
⁴ Chief Quality Officer, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Chair, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Chief, Enterprise Radiology Service, Mass General Brigham.
⁶ Vice Chair, Department of Radiology, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Director, Center for Evidence-Based Imaging, Brigham and Women's Hospital.
⁷ Associate Chair, Patient Experience and Clinically Significant Results, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: nkapoor@bwh.harvard.edu.

PMID: 38147905
DOI: 10.1016/j.jacr.2023.12.016

Abstract

Objective: Health care safety net (SN) programs can potentially improve patient safety and decrease risk associated with missed or delayed follow-up care, although they require financial resources. This study aimed to assess whether the revenue generated from completion of clinically necessary recommendations for additional imaging (RAI) made possible by an IT-enabled SN program could fund the required additional labor resources.

Methods: Clinically necessary RAI generated October 21, 2019, to September 24, 2021, were tracked to resolution as of April 13, 2023. A new radiology SN team worked with existing schedulers and care coordinators, performing chart review and patient and provider outreach to ensure RAI resolution. We applied relevant Current Procedural Terminology, version 4 codes of the completed imaging examinations to estimate total revenue. Coprimary outcomes included revenue generated by total performed examinations and estimated revenue attributed to SN involvement. We used Student's t test to compare the secondary outcome, RAI time interval, for higher versus lower revenue-generating modalities.

Results: In all, 24% (3,243) of eligible follow-up recommendations (13,670) required SN involvement. Total estimated revenue generated by performed recommended examinations was $6,116,871, with $980,628 attributed to SN. Net SN-generated revenue per 1.0 full-time equivalent was an estimated $349,768. Greatest proportion of performed examinations were cross-sectional modalities (CT, MRI, PET/CT), which were higher revenue-generating than non-cross-sectional modalities (x-ray, ultrasound, mammography), and had shorter recommendation time frames (153 versus 180 days, P < .001).

Discussion: The revenue generated from completion of RAI facilitated by an IT-enabled quality and safety program supplemented by an SN team can fund the required additional labor resources to improve patient safety. Realizing early revenue may require 5 to 6 months postimplementation.

Keywords: Radiology finance; recommendations for additional imaging; systems improvement.