Pay-for-performance scheme cuts radiology report turnaround times

by Brendon Nafziger, DOTmed News Associate Editor | August 23, 2010
Pay-for-performance
comes to radiology.
A scheme that rewards radiologists for promptly sending final reports to referring physicians could cut turnaround times by half, according to a new study.

The results lasted even after the program stopped, suggesting a change in office culture, and not just the dangling of a financial carrot, made the difference.

The study, published Friday in the September issue of the American Journal of Roentgenology, followed a program at Massachusetts General Hospital in Boston from 2006 to 2009. The program was launched after the hospital got complaints from referring physicians that preliminary reports were often left unsigned by staff radiologists, sometimes for days.

Preliminary reports are prepared by residents or fellows, under supervision of staff radiologists, after the completion of an exam. While referring doctors can use them, the reports often undergo editing during the radiologist's final review, according to Dr. Giles Boland, associate professor of radiology at Harvard Medical School, vice chairman of the department of radiology at Massachusetts General and lead author of the study.

"It's generally accepted while a preliminary report is OK, it's not the final say," he told DOTmed News.

To speed up turnaround times from generation of preliminary reports to the final signing, the program offered a reward of $2,500 every six months and $5,000 annually if radiologists had a turnaround time of less than 24 hours, investigated in a randomly chosen one-month period. After one year, the turnaround requirement was reduced to eight hours, and the annual reward cut in half.

Ultimately, the researchers examined 99,959 reports in a baseline period roughly three months before the program started, 104,673 in the months immediately following implementation of the program, and 91,379 reports after the two-year program had stopped.

The average time from getting the preliminary report to final signing-off fell dramatically, from 23 hours before the program started to 13 hours a few months after it was initiated, to four hours, two years after it ended.

Intriguingly, the entire process sped up, even though radiologists were only rewarded for the preliminary report-to-signature part. The time from completing the radiological exam to generating the preliminary report fell from 20 hours before the program to 12 hours two years later; and the total time - from completion of exam to final signing - fell by more than half, from 43 hours before the program to 32 hours shortly after the reward system started, and 16 hours after it ended.