LETTERS TO THE EDITOR What Do We Mean by Value? or any other specialty, makes an effort to follow patients forward, to Value is the current health care buzz better understand the value of a CT word. Most agree that the current scan, a consultation, or a blood test fee-for-service, transactional system from the perspective of the patient. Observations of daily living, cannot continue. Health care, like patient-reported outcomes about every other business, must move to how they view their health, have offer something resembling a guarbeen suggested by the FDA to be antee. However, the definition of part of the review process for new value seems to get diluted by what drugs and devices. Why not include we can provide today, and what we existing goods and services? should provide moving forward. When specialty services want to Recently, Richard Duszak Jr, talk about “value,” it should go beMD, commented on value for JACR [1]. In his editorial, Dr Duszak yond the buying experience. Medidescribed waves of imaging services. cine can learn a lot from other As he noted, the previous wave was service industries. We can start with based on volume. In his opinion, an extended relationship with our this needs to be replaced by a new customers—better yet, with our paradigm, one based on value, and patients. those who do not embrace this new Alan Pitt, MD wave may be left behind. He sugBarrow Neurological Institute gested supporting and promoting Department of Neuroradiology appropriateness, quality, safety, ef350 W Thomas Road ficiency, and satisfaction, all laudPhoenix, AZ 85013 able goals. However, for the most e-mail: [email protected] part, these goals stop at the point of sale, the purchase of service, without evaluating the true value of the REFERENCE good (imaging) purchased. To truly 1. Duszak R Jr. Value: imaging’s new wave demonstrate value, a customer’s imperative. J Am Coll Radiol 2013;10: 484-5. experience after the sale, his or her outcome, would need to be mea- http://dx.doi.org/10.1016/j.jacr.2013.11.003  sured. At their initial registration, S1546-1440(13)00739-4 patients could be asked to enroll in a register: “We are imaging services. Author’s Reply We care about you and your health. Would you mind if we reach back to I thank Dr Pitt for his interest in you at 3, 6, and 12 months, asking my editorial [1] and for advancing how you are?” the important conversation about This is not rocket science. Other value in medical imaging. Value is industries do something like this indeed health care’s holy grail, and with every purchase. People are opportunities abound for those enrolled in registers all the time for who seek to deliver and measure it. research. However, with the excepDr Pitt’s letter suggests that my tion of mammography, I know of commentary focused only on value no other service in which imaging, at “the point of sale” and neglected

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to consider extended patient relationships. That is anything but the case. I wrote, and continue to believe, that successful radiologists in the future “will be true consultants and integral members of coordinated and integrated delivery teams” who “will facilitate meaningful longitudinal imaging care” (emphasis added). Indeed, true value transcends our current transactional delivery system and, if achieved, will endure beyond that “point of sale.” As I [2] and others [3] have described value and quality, these terms include the very measures of shortterm and long-term outcomes Dr Pitt advocates. They are the very focus of a new series in this journal [4], which I hope readers will find both informative and provocative as we collectively strive to better understand, promote, and demonstrate value. Richard Duszak Jr, MD Harvey L. Neiman Health Policy Institute 1891 Preston White Drive Reston, VA 20191 e-mail: [email protected] REFERENCES 1. Duszak R Jr. Value: imaging’s new wave imperative. J Am Coll Radiol 2013;10:484-5. 2. Duszak R. From good to good deal: value-focused research. J Vasc Interv Radiol 2012;23:315-6. 3. Kaplan G. Seeking perfection in healthcare. In: Batalden P, ed. Lessons learned in changing healthcare. Toronto, Ontario, Canada: Longwoods; 2010. 4. Boland G, Duszak R, McGinty G, Allen B. Delivery of appropriateness, quality, safety, efficiency and patient satisfaction. J Am Coll Radiol. 2013;10:7-11. http://dx.doi.org/10.1016/j.jacr.2013.11.007  S1546-1440(13)00743-6

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What do we mean by value?

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