RESIDENTS’ AND FELLOWS’ COLUMN C. MATTHEW HAWKINS, MD
Fulfilling the Health Care Economics Milestones: Adopting an Online Curriculum for Radiology Residency Programs Allen S. Prober, MD, Eric Ledermann, DO, MBA, Alexander Norbash, MD, MHCM, William A. Mehan Jr, MD, MBA, Harprit S. Bedi, MD Arising from the ACGME 1998 Outcome Project initiative, the Next Accreditation System (NAS) was instituted in July 2013 to satisfy the need to monitor the progress of resident physicians’ training in the 6 core competencies: patient care, medical knowledge, practice-based learning and improvement, systems-based practice (SBP), professionalism, and interpersonal skills and communication. The NAS emphasizes an outcomes-based educational system that sequentially tiers and outlines the necessary skills and knowledge that residents must learn and demonstrate during their residency training. It also establishes more detailed systems and methods than previously described to evaluate proficiency within these 6 core competencies [1,2]. Part of the NAS is a standard to which residents and programs can refer while tracking through their training. The ACGME and the ABR collaborated on The Diagnostic Radiology Milestone Project. In 2012, this working group developed milestones for the 6 core competencies. The milestones “provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty” [3]. The milestones comprise sequentially increasing levels of knowledge, skills, attitudes, and other
314
attributes for each of the ACGME competencies organized in a developmental framework. They are descriptors and targets for resident performance through the radiology residency; a level is completed when the resident attains the milestones in that level (Table 1). Nicholson et al [2] allude to various methods and varying spans of time for sequential progression through the milestones during a radiology residency. For example, in many programs, the medical knowledge competency will be “attained in sequential order by levels that correspond to the year of residency training. Other milestones may be better suited to facilitating residents to achieve all levels in a single rotation or by way of a dedicated curriculum designed specifically to meet that milestone.” They go on to explain that the health care economics milestones specifically, as incorporated into the SBP competency, may be achieved by this latter technique of a dedicated curriculum [2]. Of the 6 core competencies, SBP is perhaps the least intuitive to most residents, owing to “the traditional focus of radiology residency programs on teaching successful interpretation and performance of diagnostic images and procedures, respectively” [4], and corresponding with a dearth of SBP curricula in most residency programs.
Compounding the limited amount of available curriculum is the lack of equal resident concentration on the nonclinical curriculum. Some, if not most residents, given the largely unfamiliar nature of SBP and the morepressing needs to learn important interpretive skills within the finite educational time available, tend to show less interest in SBP’s fundamental aspects: health care economics and business practice [5]. However, numerous voices in recent years have promoted the importance of mastering business concepts for residents and practicing radiologists, to ensure successful practice in the 21st century [4,6-8]. Because of its newly acknowledged importance and establishment as a core competency, SBP will require a robust effort to effectively compete with the evolutionary level and progress realized by the other competencies. Aiming to distill the essential components of SBP into a set of milestones, Todd Miller and Charles Resnik [9], in conjunction with the Association of Program Directors in Radiology (APDR), delineated 5 specific, achievable deliverables as part of the health care economics milestones (outlined in Table 2), matched with each milestone-level definition. Before the release of the health care economics milestones, surveys of residents and radiology residency
1546-1440/15/$36.00
n
ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2014.09.030
Table 1. Milestone definitions from The Diagnostic Radiology Milestone Project, developed in 2012 by collaboration of the ACGME and the ABR Level 1 2 3
4
5
Milestone Definition The resident demonstrates milestones expected of one who has had some education in diagnostic radiology. The resident is advancing and demonstrating additional milestones. The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for radiology. The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals, which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this goal.
program directors acknowledged an unmet need to address business concepts in residency [4]. Some programs had addressed this need by incorporating unique curricula developed and administered by faculty well versed in the subject. For example, Stephen Chan details a seminar-based, 4-year Radiology Management curriculum at the Columbia University program, which was welcomed by residents and faculty alike [10]. Scott Mirowitz and others [11,12] described a new curriculum at the Washington University program, which was so well received that 61% of polled residents can see
themselves personally involved in administration or organized radiology. Finally, Otero et al [13] developed a comprehensive, 2-year curriculum to address the full gamut of SBP concepts. Features shared by these curricula are relatively short-interval, didactic sessions (up to 1 hour), combined with case-based discussions. As effective as the aforementioned curricula are, they arise from larger academic programs with the resources to provide faculty who have a professional or educational background in radiology management and business practice. However, smaller programs
with fewer resources, and faculty who are relatively inexperienced in business, are challenged to duplicate such successes. Nicholson et al [2] explain that one of the aims of the milestone project is to “foster creative and innovative solutions to meet . . . curricular gaps” brought to light by implementation of the milestones. As programs address these curriculum requirements, there “will be the development of materials and curricula that can be shared with other institutions, resulting in the standardization of practice; development of best practices; and decreasing the variability of graduate medical training in radiology.” In that spirit, we reviewed the APDR’s suggested resources to evaluate how a single curriculum could be universally applied to residency programs. Currently, many resources are available that aim to teach the skills and knowledge required to become savvy in the topics comprising health care economics as they relate to radiology. One of the most popular of these resources is the Business of Radiology online video lecture series by David Yousem [14]. Although learning the information on the videos would certainly fulfill the milestone
Table 2. The health care economics milestones, matched with each milestone-level definition, adapted from The Diagnostic Radiology Milestone Project [3] and the Association of Program Directors in Radiology [9] Level 1 2 3
4
5
Milestone Definition The resident demonstrates milestones expected of one who has had some education in diagnostic radiology. The resident is advancing and demonstrating additional milestones. The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for radiology. The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals, which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this goal.
SBP2: Health Care Economics Describes the mechanisms for reimbursement, including types of payers States relative cost of common procedures Describes the technical and professional components of imaging costs Describes measurements of productivity (eg, relative value units) Describes the radiology revenue cycle
Note: SBP ¼ systems-based practice.
Journal of the American College of Radiology Prober, Ledermann, Norbash n Residents’ and Fellows’ Column
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criteria, the 21 videos each average 45 minutes and are fairly technical; therefore, they seem to be unsuitable for most radiology residents. Radiology journals such as JACR, American Journal of Roentgenology, and Academic Radiology have published numerous articles targeted at educating the radiology community about health care economics, covering such topics as financial terminology, financial statements, contracts, practice management, among others [15-18]. Unfortunately, these resources tend to be scattered, with overlapping scope and target audience. Given the variability, much of this content is not necessarily focused toward directly addressing the health care economics milestones as outlined by the APDR. The issue of educating the radiology community in finance and leadership is not isolated to radiology trainees. Given the recognition of the changing health care landscape facing radiology, in 2012, the ACR developed the Radiology Leadership Institute (RLI). The blended live and online curriculum of the RLI is designed to deliver “advanced leadership courses—designed for various levels of professional experience—that build to high proficiencies of leadership acumen” [19]. The RLI curriculum, much of which is free or heavily discounted for ACR members-intraining, in part provides on-demand webinars for enrollees (trainees and professionals alike) to complete during their progression through the RLI’s proprietary levels, which are described on a progressive and sequential learning-level scale of I-IV. It is through this “on-demand learning portal” that radiology residents now have access to the RLI-ACGME 2014 HC Economics Milestones Program webinar (HC for health care), which was initially presented during the ACR Residents’ and Fellows’ meeting in Washington, DC in April 2014 [20]. This webinar 316
includes a package of selected JACR reading material to serve as a more detailed adjunct to the prerecorded presentations, to bring residents up to speed on the vocabulary of economics [16], Current Procedural Terminology codes, the resource-based relative value scale [21], and the effects of this scale on radiology practice [22,23]. These resources help condense the essential elements of the health care economics milestones into a single 2-hour presentation readily available for online viewing. The webinar contains 4 presentations of 15-20 minutes each, given by nationally known leaders in radiology on topics pertaining to each of the 5 APDR milestones. Geraldine McGinty, MD, MBA, in the level-1 presentation, discusses the various payers in the health care economy and how health care payment policy affects the practice of radiology, including possible obstacles to payment. Ezequiel Silva III, MD, in the level-2 and level-3 presentation, discusses the resource-based relative value scale underlying professional and technical fee reimbursements and how it translates into payment. Richard Duszak Jr, MD, in the level-4 presentation, outlines the relative value units system and its impact on radiology practice. William T. Thorwarth Jr, MD, in the level-5 presentation, details CPT coding and its function in the radiology revenue cycle. In addition to the presentations described, the upcoming RLI webinar series Beyond the Health Care Economics Milestones, beginning in September 2014, delves deeper into the aforementioned topics, as well as their integration and relevance to radiology practice [24]. Our goal was to investigate the utility of this initial webinar and its potential as a logical framework upon which a scalable curriculum could be developed, distributed, and broadly implemented to fulfill the APDR milestone criteria. Collins et al [25] previously described a joint venture
between the ACR and the APDR to present and evaluate the effectiveness of a series of videos teaching residents noninterpretive skills, such as job search and contracting skills, business aspects of radiology, medical organizational politics, and others. Their project concluded that the videos were an effective educational resource that could serve as an effective model for greater future curricular development and more-widespread distribution. Building on this concept, the RLI webinars summarize the span of knowledge currently available in a more digestible and structured manner, allowing already overburdened radiology residents with little business experience to gain a foothold into health care economics at their own pace. The webinar and follow-up series may be of specific value to smaller academic or community programs, which may not have the resources to address and develop curricula that respond to the milestones independently, and likely do not have a ready-made curriculum that fulfills the requirements outlined by the APDR. In addition to providing content to instruct, the webinar helps fulfill a companion requirement of the NAS: development of milestone-assessment methods [26]. The curriculum proposed by Otero et al [13] introduces the concept of measuring achievement by having second-year residents, after completion of seminar-based instruction in the first year, contribute to ongoing projects and apply their knowledge to the practical components of systems-based practice. Although this approach is no doubt an effective assessment method, it again raises the question of how a program with fewer available dedicated resources and perhaps a relative lack of business-versed physician staff is to oversee such specific practicum projects. The RLI webinar simplifies the feedback process by incorporating an automated posttest that requires the viewer to correctly
Journal of the American College of Radiology Volume 12 n Number 3 n March 2015
answer an appropriate number of questions to gain credits for the activity. This model echoes the current RSNA/ American Association of Physicists in Medicine online physics modules, which have proven over time to be an effective means of learning and assessing progress through radiology physics curricula [27]. We believe that the RLI-ACGME 2014 HC Economics Milestones Program webinar, in conjunction with review of the associated readings and completion of the posttest, allows radiology residents to efficiently and independently progress through the 5 health care economics milestones and provides for greater retention and appreciation of the SBP core competency. With addition of the upcoming webinar series, these materials will allow program directors to effectively adhere to the changes instituted by the NAS, via fulfillment of both the educational requirement and an assessment methodology for teaching SBP. The program is easily scalable and can be integrated as a modular component within a broader residency-specific health economics curriculum. Ultimately, the goal is to train the next generation of radiologists to be more aware of their place in the broader health care economy and to provide a foundation for them to develop careers as confident practice leaders.
ACKNOWLEDGEMENTS The authors thank Anne Marie Pascoe and greatly appreciate the efforts of the RLI, the ACR, and the presenters and collaborators that produced the online material outlined in this article.
REFERENCES 1. Nasca TJ, Philibert I, Brigham T, Flynn TC. The Next GME Accreditation System— rationale and benefits. N Engl J Med 2012;366:1051-6. 2. Nicholson BT, Paladin AM, Oldham SA, et al. The Next Accreditation System in radiology: a report from the APDR Residency Structure Committee. J Am Coll Radiol 2014;11:407-12. 3. ACGME and ABR. The Diagnostic Radiology Milestone Project. Available at: https://www.acgme.org/acgmeweb/Portals/ 0/PDFs/Milestones/DiagnosticRadiology Milestones.pdf. Accessed April 24, 2014. 4. Medverd JR, Dicks DL, Tang J, et al. Business of radiology 101: the state of radiology business practice and health care policy curricula at US radiology residency programs. J Am Coll Radiol 2012;9:174180.e1. 5. McArthur TA, Prince EL, Berland LL, et al. Introduction to business for radiology senior residents. J Am Coll Radiol 2011;8: 205-8. 6. Medverd JR, Prabhu SJ, Lam DL. Business of radiology: financial fundamentals for radiologists. AJR Am J Roentgenol 2013;201:W683-90. 7. McLoud TC. Education in radiology. AJR Am J Roentgenol 2000;174:3-8. 8. Lexa FJ. Medicine and business: clash of cultures or a great opportunity for the 21st century? J Am Coll Radiol 2005;2:218-9. 9. Miller T, Resnik C. Health care economics. Available at: http://apdr.org/template.aspx? id¼1013. Accessed April 22, 2014. 10. Chan S. Management education during radiology residency: development of an educational practice. Acad Radiol 2004;11: 1308-17. 11. Mirowitz SA. Development and assessment of a radiology core curriculum in health care policy and practice. Acad Radiol 2000;7:540-50. 12. Medverd JR, Kohr J, Stratil P. Fall 2009 University of Washington Business of Radiology curriculum. Available at: http://www. rad.washington.edu/academics/residency/cur rentres/education-resources/radiology-busi ness-practice-health-care-policy/uw-businessof-radiology-resident-sessions-website. Accessed May 4, 2014. 13. Otero HJ, Weissman BN, Rybicki FJ. System-based practice: proposal for a comprehensive curriculum. Acad Radiol 2008;15:119-26.
14. Yousem DM. Business of radiology. Available at: http://webcast.jhu.edu/Mediasite/Catalog/ Full/7e18b7d59c63487eaaf177a86f83b01121. Accessed April 28, 2014. 15. Neiman HL. Practical business aspects of radiology. AJR Am J Roentgenol 2000;174: 1523-8. 16. Silva E III. Econ speak 101. J Am Coll Radiol 2014;11:343-4. 17. Lam DL, Medverd JR. How radiologists get paid: resource-based relative value scale and the revenue cycle. AJR Am J Roentgenol 2013;201:947-58. 18. Berlin JW, Lexa FJ. Finance for practicing radiologists. J Am Coll Radiol 2005;2: 254-61. 19. ACR. Radiology Leadership Institute Program. Available at: http://www.radiologyleaders.org/ program. Accessed July 17, 2014. 20. ACR. RLI-ACGME 2014 HC Economics Milestones Program. Available at: https:// shop.acr.org/Default.aspx?TabID=55&Pro ductId=219541520. Accessed July 20, 2014. 21. Allen B Jr. Valuing the professional work of diagnostic radiologic services. J Am Coll Radiol 2007;4:106-14. 22. Duszak R Jr, Muroff LR. Measuring and managing radiologist productivity, part 1: clinical metrics and benchmarks. J Am Coll Radiol 2010;7:452-8. 23. Duszak R Jr, Muroff LR. Measuring and managing radiologist productivity, part 2: beyond the clinical numbers. J Am Coll Radiol 2010;7:482-9. 24. ACR. RLI leadership webinars. Available at: http://www.radiologyleaders.org/meetingsand-courses/webinars. Accessed July 26, 2014. 25. Collins J, Amsel S, Alderson PO. Teaching noninterpretive skills to radiology residents: a collaborative effort between the ACR and the Association of Program Directors in Radiology. Acad Radiol 2001;8:903-7. 26. Ling L, Derstine P, Cohen N. ACGME webinar 3: implementing milestones and clinical competency committees. Available at: https://www.acgme.org/acgmeweb/ Portals/0/PDFs/ACGMEMilestones-CCCAssesmentWebinar.pdf. Accessed June 3, 2014. 27. Shankar PR, Woodard J, Heller MT, Agarwal V, Orons PD. Implementation and outcomes of a resident-led physics curriculum with integration of the RSNA/ AAPM physics modules. Acad Radiol 2013;20:1306-10.
Allen S. Prober, MD, William A. Mehan, Jr, MD, MBA, and Harprit S. Bedi, MD, are from the Department of Radiology, Tufts Medical Center, Boston, Massachusetts. Eric Ledermann, DO, MBA, is from the Department of Radiology, State University of New York Downstate Medical Center, Brooklyn, New York. Alexander Norbash, MD, MHCM, is from the Boston University School of Medicine, Boston, Massachusetts. Allen S. Prober, MD: Tufts Medical Center—Department of Radiology, 800 Washington Street, Box 299, Boston, MA 02111; e-mail: [email protected].
Journal of the American College of Radiology Prober, Ledermann, Norbash n Residents’ and Fellows’ Column
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Fulfilling the Health Care Economics Milestones: Adopting an Online Curriculum for Radiology Residency Programs Allen S. Prober, MD, Eric Ledermann, DO, MBA, Alexander Norbash, MD, MHCM, William A. Mehan Jr, MD, MBA, Harprit S. Bedi, MD Arising from the ACGME 1998 Outcome Project initiative, the Next Accreditation System (NAS) was instituted in July 2013 to satisfy the need to monitor the progress of resident physicians’ training in the 6 core competencies: patient care, medical knowledge, practice-based learning and improvement, systems-based practice (SBP), professionalism, and interpersonal skills and communication. The NAS emphasizes an outcomes-based educational system that sequentially tiers and outlines the necessary skills and knowledge that residents must learn and demonstrate during their residency training. It also establishes more detailed systems and methods than previously described to evaluate proficiency within these 6 core competencies [1,2]. Part of the NAS is a standard to which residents and programs can refer while tracking through their training. The ACGME and the ABR collaborated on The Diagnostic Radiology Milestone Project. In 2012, this working group developed milestones for the 6 core competencies. The milestones “provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty” [3]. The milestones comprise sequentially increasing levels of knowledge, skills, attitudes, and other
314
attributes for each of the ACGME competencies organized in a developmental framework. They are descriptors and targets for resident performance through the radiology residency; a level is completed when the resident attains the milestones in that level (Table 1). Nicholson et al [2] allude to various methods and varying spans of time for sequential progression through the milestones during a radiology residency. For example, in many programs, the medical knowledge competency will be “attained in sequential order by levels that correspond to the year of residency training. Other milestones may be better suited to facilitating residents to achieve all levels in a single rotation or by way of a dedicated curriculum designed specifically to meet that milestone.” They go on to explain that the health care economics milestones specifically, as incorporated into the SBP competency, may be achieved by this latter technique of a dedicated curriculum [2]. Of the 6 core competencies, SBP is perhaps the least intuitive to most residents, owing to “the traditional focus of radiology residency programs on teaching successful interpretation and performance of diagnostic images and procedures, respectively” [4], and corresponding with a dearth of SBP curricula in most residency programs.
Compounding the limited amount of available curriculum is the lack of equal resident concentration on the nonclinical curriculum. Some, if not most residents, given the largely unfamiliar nature of SBP and the morepressing needs to learn important interpretive skills within the finite educational time available, tend to show less interest in SBP’s fundamental aspects: health care economics and business practice [5]. However, numerous voices in recent years have promoted the importance of mastering business concepts for residents and practicing radiologists, to ensure successful practice in the 21st century [4,6-8]. Because of its newly acknowledged importance and establishment as a core competency, SBP will require a robust effort to effectively compete with the evolutionary level and progress realized by the other competencies. Aiming to distill the essential components of SBP into a set of milestones, Todd Miller and Charles Resnik [9], in conjunction with the Association of Program Directors in Radiology (APDR), delineated 5 specific, achievable deliverables as part of the health care economics milestones (outlined in Table 2), matched with each milestone-level definition. Before the release of the health care economics milestones, surveys of residents and radiology residency
1546-1440/15/$36.00
n
ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2014.09.030
Table 1. Milestone definitions from The Diagnostic Radiology Milestone Project, developed in 2012 by collaboration of the ACGME and the ABR Level 1 2 3
4
5
Milestone Definition The resident demonstrates milestones expected of one who has had some education in diagnostic radiology. The resident is advancing and demonstrating additional milestones. The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for radiology. The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals, which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this goal.
program directors acknowledged an unmet need to address business concepts in residency [4]. Some programs had addressed this need by incorporating unique curricula developed and administered by faculty well versed in the subject. For example, Stephen Chan details a seminar-based, 4-year Radiology Management curriculum at the Columbia University program, which was welcomed by residents and faculty alike [10]. Scott Mirowitz and others [11,12] described a new curriculum at the Washington University program, which was so well received that 61% of polled residents can see
themselves personally involved in administration or organized radiology. Finally, Otero et al [13] developed a comprehensive, 2-year curriculum to address the full gamut of SBP concepts. Features shared by these curricula are relatively short-interval, didactic sessions (up to 1 hour), combined with case-based discussions. As effective as the aforementioned curricula are, they arise from larger academic programs with the resources to provide faculty who have a professional or educational background in radiology management and business practice. However, smaller programs
with fewer resources, and faculty who are relatively inexperienced in business, are challenged to duplicate such successes. Nicholson et al [2] explain that one of the aims of the milestone project is to “foster creative and innovative solutions to meet . . . curricular gaps” brought to light by implementation of the milestones. As programs address these curriculum requirements, there “will be the development of materials and curricula that can be shared with other institutions, resulting in the standardization of practice; development of best practices; and decreasing the variability of graduate medical training in radiology.” In that spirit, we reviewed the APDR’s suggested resources to evaluate how a single curriculum could be universally applied to residency programs. Currently, many resources are available that aim to teach the skills and knowledge required to become savvy in the topics comprising health care economics as they relate to radiology. One of the most popular of these resources is the Business of Radiology online video lecture series by David Yousem [14]. Although learning the information on the videos would certainly fulfill the milestone
Table 2. The health care economics milestones, matched with each milestone-level definition, adapted from The Diagnostic Radiology Milestone Project [3] and the Association of Program Directors in Radiology [9] Level 1 2 3
4
5
Milestone Definition The resident demonstrates milestones expected of one who has had some education in diagnostic radiology. The resident is advancing and demonstrating additional milestones. The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for radiology. The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals, which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this goal.
SBP2: Health Care Economics Describes the mechanisms for reimbursement, including types of payers States relative cost of common procedures Describes the technical and professional components of imaging costs Describes measurements of productivity (eg, relative value units) Describes the radiology revenue cycle
Note: SBP ¼ systems-based practice.
Journal of the American College of Radiology Prober, Ledermann, Norbash n Residents’ and Fellows’ Column
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criteria, the 21 videos each average 45 minutes and are fairly technical; therefore, they seem to be unsuitable for most radiology residents. Radiology journals such as JACR, American Journal of Roentgenology, and Academic Radiology have published numerous articles targeted at educating the radiology community about health care economics, covering such topics as financial terminology, financial statements, contracts, practice management, among others [15-18]. Unfortunately, these resources tend to be scattered, with overlapping scope and target audience. Given the variability, much of this content is not necessarily focused toward directly addressing the health care economics milestones as outlined by the APDR. The issue of educating the radiology community in finance and leadership is not isolated to radiology trainees. Given the recognition of the changing health care landscape facing radiology, in 2012, the ACR developed the Radiology Leadership Institute (RLI). The blended live and online curriculum of the RLI is designed to deliver “advanced leadership courses—designed for various levels of professional experience—that build to high proficiencies of leadership acumen” [19]. The RLI curriculum, much of which is free or heavily discounted for ACR members-intraining, in part provides on-demand webinars for enrollees (trainees and professionals alike) to complete during their progression through the RLI’s proprietary levels, which are described on a progressive and sequential learning-level scale of I-IV. It is through this “on-demand learning portal” that radiology residents now have access to the RLI-ACGME 2014 HC Economics Milestones Program webinar (HC for health care), which was initially presented during the ACR Residents’ and Fellows’ meeting in Washington, DC in April 2014 [20]. This webinar 316
includes a package of selected JACR reading material to serve as a more detailed adjunct to the prerecorded presentations, to bring residents up to speed on the vocabulary of economics [16], Current Procedural Terminology codes, the resource-based relative value scale [21], and the effects of this scale on radiology practice [22,23]. These resources help condense the essential elements of the health care economics milestones into a single 2-hour presentation readily available for online viewing. The webinar contains 4 presentations of 15-20 minutes each, given by nationally known leaders in radiology on topics pertaining to each of the 5 APDR milestones. Geraldine McGinty, MD, MBA, in the level-1 presentation, discusses the various payers in the health care economy and how health care payment policy affects the practice of radiology, including possible obstacles to payment. Ezequiel Silva III, MD, in the level-2 and level-3 presentation, discusses the resource-based relative value scale underlying professional and technical fee reimbursements and how it translates into payment. Richard Duszak Jr, MD, in the level-4 presentation, outlines the relative value units system and its impact on radiology practice. William T. Thorwarth Jr, MD, in the level-5 presentation, details CPT coding and its function in the radiology revenue cycle. In addition to the presentations described, the upcoming RLI webinar series Beyond the Health Care Economics Milestones, beginning in September 2014, delves deeper into the aforementioned topics, as well as their integration and relevance to radiology practice [24]. Our goal was to investigate the utility of this initial webinar and its potential as a logical framework upon which a scalable curriculum could be developed, distributed, and broadly implemented to fulfill the APDR milestone criteria. Collins et al [25] previously described a joint venture
between the ACR and the APDR to present and evaluate the effectiveness of a series of videos teaching residents noninterpretive skills, such as job search and contracting skills, business aspects of radiology, medical organizational politics, and others. Their project concluded that the videos were an effective educational resource that could serve as an effective model for greater future curricular development and more-widespread distribution. Building on this concept, the RLI webinars summarize the span of knowledge currently available in a more digestible and structured manner, allowing already overburdened radiology residents with little business experience to gain a foothold into health care economics at their own pace. The webinar and follow-up series may be of specific value to smaller academic or community programs, which may not have the resources to address and develop curricula that respond to the milestones independently, and likely do not have a ready-made curriculum that fulfills the requirements outlined by the APDR. In addition to providing content to instruct, the webinar helps fulfill a companion requirement of the NAS: development of milestone-assessment methods [26]. The curriculum proposed by Otero et al [13] introduces the concept of measuring achievement by having second-year residents, after completion of seminar-based instruction in the first year, contribute to ongoing projects and apply their knowledge to the practical components of systems-based practice. Although this approach is no doubt an effective assessment method, it again raises the question of how a program with fewer available dedicated resources and perhaps a relative lack of business-versed physician staff is to oversee such specific practicum projects. The RLI webinar simplifies the feedback process by incorporating an automated posttest that requires the viewer to correctly
Journal of the American College of Radiology Volume 12 n Number 3 n March 2015
answer an appropriate number of questions to gain credits for the activity. This model echoes the current RSNA/ American Association of Physicists in Medicine online physics modules, which have proven over time to be an effective means of learning and assessing progress through radiology physics curricula [27]. We believe that the RLI-ACGME 2014 HC Economics Milestones Program webinar, in conjunction with review of the associated readings and completion of the posttest, allows radiology residents to efficiently and independently progress through the 5 health care economics milestones and provides for greater retention and appreciation of the SBP core competency. With addition of the upcoming webinar series, these materials will allow program directors to effectively adhere to the changes instituted by the NAS, via fulfillment of both the educational requirement and an assessment methodology for teaching SBP. The program is easily scalable and can be integrated as a modular component within a broader residency-specific health economics curriculum. Ultimately, the goal is to train the next generation of radiologists to be more aware of their place in the broader health care economy and to provide a foundation for them to develop careers as confident practice leaders.
ACKNOWLEDGEMENTS The authors thank Anne Marie Pascoe and greatly appreciate the efforts of the RLI, the ACR, and the presenters and collaborators that produced the online material outlined in this article.
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Allen S. Prober, MD, William A. Mehan, Jr, MD, MBA, and Harprit S. Bedi, MD, are from the Department of Radiology, Tufts Medical Center, Boston, Massachusetts. Eric Ledermann, DO, MBA, is from the Department of Radiology, State University of New York Downstate Medical Center, Brooklyn, New York. Alexander Norbash, MD, MHCM, is from the Boston University School of Medicine, Boston, Massachusetts. Allen S. Prober, MD: Tufts Medical Center—Department of Radiology, 800 Washington Street, Box 299, Boston, MA 02111; e-mail: [email protected].
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