As the call for quality rises, radiology needs to be proactive in helping to build meaningful and appropriate metrics.

This is a question that radiology ought to consider. The call for quality in medicine is coming from many quarters: government organizations, payors, and most recently CMS Administrator Thomas Scully, who threatened to make hospital quality reporting mandatory if more hospitals do not voluntarily submit data on quality indicators for acute myocardial infarction, heart failure, and pneumonia. Currently, most quality initiatives are aimed at hospitals, including the widely publicized Leapfrog Organization’s campaign. Some payors, however, are developing quality measures aimed at physician groups, primarily IPAs and multispecialty medical groups that have assumed risk for large populations of patients. These programs are rewarding the top-rated physician groups with significant financial incentives for quality performance.

For those skeptical about large purchasers bearing financial gifts in these times of greater scrutiny of health care costs, some enlightened employers have bought into the idea that quality health care can save them money. The Pacific Business Group on Health for Quality Measurement and Improvement, San Francisco, is a coalition of 48 large California health purchasers representing $4 billion in premiums bought annually on behalf of their employees. It sits on the steering and technical committees of California’s Pay for Performance program, developed by Walnut Creek, Calif-based Integrated Healthcare Association, which employs metrics to measure quality, patient satisfaction, and information technology improvements to patient service. Six payors will pay their first bonuses this coming summer, and the winners stand to gain a lot.

According to Diane Stewart, senior manager for Pacific Business Group, whose members include Wells Fargo, CalPERS, Cisco Systems, and Hughes Aircraft, the quality movement is gaining momentum. “It is based on the belief that higher quality care actually costs less, so we are supportive of more dollars going to higher quality providers who can demonstrate better outcomes. We are very supportive of reallocating the dollars: right now, the same price is paid to everyone.” While the Pay for Performance program is aimed at integrated medical groups, those groups in turn contract with specialty groups, including radiologists. “There is increasing interest among California medical groups in setting up incentive programs for their specialty physicians,” notes Stewart. “They want to align incentives for their physicians.”

Radiology is not in the cross-hairs of the quality movement at the moment, though one of the earliest and enduring measures of a health plan’s quality is breast cancer screening rates, measured by the number of women aged 52-69 who had at least one mammogram in the past 2 years. This is a measure that plans clearly need help with: the 2002 breast cancer screening rates for commercial plans and Medicare dropped slightly, from 75.5 to 74.9, and 75.3 to 74.5, respectively, the first declines in 6 years.1  Of the 30 “safe practices” endorsed by the not-for-profit National Quality Forum, convened to implement a national strategy for national health care measurement and reporting ( ), just one relates to radiology, No. 13: Implement a standardized protocol to prevent the mislabeling of radiographs.

What is quality? For Chambersburg Imaging Associates (CIA), Chambersburg, Pa, which has been working under the direction of Robert Pyatt, MD, on defining and measuring quality for some years, quality is more than a carrot-and-stick deal, it is an overall pursuit of excellence that extends into every corner of the practice (see article, page 63). Ultimately, quality radiology is best defined by radiology. As the demand for quality in medicine grows, radiology needs to be proactive in helping to build meaningful and appropriate metrics that will have the maximum positive impact on patient health.

Cheryl Proval
[email protected]


  1. The State of Health Care Quality: 2003. Washington, DC: National Committee for Quality Assurance; 2003:28.