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Monday, December 02, 2013

Shifting Healthcare Landscape Creates Threats, Challenges

Vijay M. Rao, M.D.

With the implementation of the Affordable Care Act, the introduction of new payment models, and a shift from volume- to value-based radiology, radiologists are facing a number of challenges as they head into the foreseeable future.

But there are several steps radiologists can take to deal with these challenges going forward, according Vijay M. Rao, M.D., David C. Levin, M.D., and Jonathan W. Berlin, M.D. They presented a Sunday refresher course, "The Future of Radiology: What are the Threats and How to Respond to Them."

While all three radiologists addressed the same topic just one year ago at RSNA 2012, some circumstances have changed since then, said Dr. Rao, RSNA Board Liaison for Information Technology and Annual Meeting. "People were still wondering about the Affordable Care Act and whether that really meant a change from volume- to value-based radiology," she said. "That has become a reality and now we are focusing on quality metrics. It's becoming important for us to become champions of quality in our institutions."

David C. Levin, M.D.

Dr. Rao urged radiologists to become more visible within the hospital environment, particularly with the evolution and adoption of new payment models. "One thing that clearly needs to happen is that radiologists need to build bridges to hospital administrations," she said. "As we evolve into bundled payments or the formation of ACOs (accountable care organizations), we're no longer talking about fee-for-service, so radiologists may be in an unfavorable position unless the hospital recognizes their value."

Radiologists also need to increase their visibility by becoming more involved in areas like hospital strategic planning, attending medical executive committee meetings, and/or working to reduce overall costs.

In the meantime, many of the challenges that have been afflicting radiology over the last several years continue to do so. Dr. Levin pointed out that it's clear that the perception that radiology is a commodity continues to dog the specialty. He pointed to a recent article in the New England Journal of Medicine that called for Medicare to "extend competitive bidding to medical devices, lab tests, radiology diagnostic services and all other commodities."

Jonathan W. Berlin, M.D.

"There we are identified as a commodity like broccoli and toilet paper," Dr. Levin said. "That's the way we are being perceived by a lot of intelligent people."

A "culture change" is needed, Dr. Levin said—radiologists must act like true consulting physicians by screening imaging exams for appropriateness, supervising advanced imaging exams, giving patients access to their test results, and being available to consult with referring physicians.

In order to do these things, radiologists will have to change the way they look at productivity, Dr. Levin said. Co-presenter Dr. Berlin pointed out that in order to deal with declining reimbursements, radiologists have focused on increasing productivity while cutting expenses and reducing hiring.

This is problematic on several levels, Dr. Berlin said. It's a problem when radiologists fail to pick up the phone or reach out to other clinicians or residents because these activities won't increase RVUs, he said.

"Behave more like consulting physicians," Dr. Levin said, "even if it means we have to sacrifice some income to do it."

Dr. Levin also urged radiologists to "take back the nights and weekends" from teleradiology companies; consider consolidating into larger groups in order to better cover those times as well as provide subspecialty expertise and achieve more market power and economies of scale; do more to publicize ACR appropriateness criteria; and build bridges to primary care physicians who will be increasingly influential under new payment models.

Radiologists as Utilization Gatekeepers

In terms of utilization management, radiologists need to take on a larger role, Dr. Rao said. In the past radiologists have shied away from becoming utilization gatekeepers, Dr. Rao said, partly due to financial interests, as well as the possibility of alienating their colleagues by rejecting imaging tests as unnecessary.

"This is where radiologists have to take a leadership role in reducing unnecessary imaging," she said.

Taking on that role can be accomplished in several ways, including educating medical students, staff and referring physicians about appropriate imaging and working with hospitals to install decision support systems linked to order entry.

Another major concern is that a bigger segment of the radiology job market is contracting. And a poor job market means "less clout and prestige for the specialty," said Dr. Berlin, as well as less added-valued as perceived by referring physicians and patients.

Groups should be prepared to hire more young radiologists, even if it means sacrificing income, Dr. Rao said. "We don't want to send the message to medical students that there aren't any jobs available in radiology. Radiology has always attracted the best and the brightest and we don't want to see them shy away from entering the specialty."

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© 2013 RSNA. The RSNA 2013 Daily Bulletin is the official publication of the 99th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published Sunday, December 1 - Thursday, December 5.

The RSNA 2013 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.

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