There is no doubt that MRI has revolutionized healthcare in the past three decades. MR allows early detection of a disease, assessment of severity of illness, and monitoring of disease progress for many conditions. Perhaps because of this progress in MR technology, MR utilization has increased dramatically. Accordingly, MR has been viewed as one of the potential contributors to the rising healthcare costs. Under the current active discussion of healthcare transformation, it is a perfect opportunity for the entire MR community to deliberate the value of MRI and strategize how to increase value of MR for patient care. In this presentation, I would like to provide the framework for a high-level system overview of how we should measure and improve value of MRI in the US health system. There are four key stakeholders in the MRI value discussion: patients (the most important), referring providers, hospitals and clinics, and payers/governments. It is essential to understand what each stakeholder wants or needs from MR or information obtained from MRI. Patients want first an accurate diagnosis and lower cost (copay or out of pocket expense), then shorter scan time, easy access, convenient and flexible hours (late evening or weekends), and comfortable table/magnet bores. Referring physicians want an accurate diagnosis and actionable reports, timely and effective communication, high-quality images, and focused protocols to answer specific clinical questions. Hospitals and clinics want efficient and streamlined operation, access, an exceptional patient experience, safety, timely and accurate diagnosis, and financial margin. Payers want appropriate utilization of MR, low cost (expense), accurate and timely diagnosis, reduction of repeated imaging. It becomes clear that the common elements of envisioned as a Venn diagram include a focused MR protocol with shorter scan time, reduced cost and accurate, timely, and actionable diagnosis. Quantitative rather than qualitative imaging, standardization of diagnoses using specific codes or categories rather than narrative statements certainly moves us toward “actionable” diagnosis and effective communication of medical information. What is critical for the MRI community, particularly with the rapid changes in the healthcare payment system, is to demonstrate the value of MRI to various stakeholders. Value of care is defined by outcomes achieved per cost (1). While therapeutic intervention directly influences outcomes, a diagnostic test such as MRI has a distant relationship with clinical outcomes. A question is how we define value of imaging to various stakeholders. Accordingly, the focus should be on the intermediate outcomes such as treatment decisions or management changes, reaching beyond the traditional diagnostic accuracy or agreement measures. These intermediate outcomes include the impact of MRI on process measures, such as ED length of stay, time to treatment (i.e. TPA, surgery), as well as direct impact of therapy, such as avoidance of unnecessary treatment or intervention. Furthermore, it is essential to measure the impact of cost saving that MRI would bring to the entire health system by triaging patients to appropriate management, avoiding unnecessarily or ineffective treatments, or assuring absence of severe disease to patients and referring providers. The challenges we face provides strong motivation and incentives for us to make processes and strategies for developing high-value MRI. By doing so, imaging will become the value center, not the cost center, for the health system and patient care spectrum.

Acknowledgements

No acknowledgement found.

References

1. Porter, M.E., What is value in health care? NEJM, 2010. 363(26): p. 2477-81.