Where’s the patient?

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A couple of years ago I took a fall that resulted in me spraining my right ankle. Like most people, I won’t pay to go to an ER unless I have a bone showing somewhere, so instead of seeking the only medical attention available to me at 8 p.m., I attempted to sleep through the night, then got up and drove to work using my left foot instead of my right. “I just twisted it badly,” I kept telling myself, until a co-worker took one look at my swollen foot and ordered me to see a doctor. I was writing about radiology then, too, but I was relieved when the doctor I visited later that day flipped on his own x-ray to take images of my foot. If he’d wanted to use his own MRI I wouldn’t have batted an eye. A referral to an imaging center would’ve been a massive annoyance, especially since I was having trouble driving. And honestly, by then I just wanted to get to the part where someone handed me a prescription for painkillers. I was seeing the patient side of the in-office imaging I’d so regularly railed against as an editor in this field, and it looked pretty different. I think about that incident a lot these days. Watching radiologists face the decision to become hospital-employed or cope with big reimbursement cuts, I understand the business concerns of the imaging professionals with whom I interact on a daily basis; but I also ask myself, “What’s the patient care argument against this?” If better alignment between hospitals and radiologists leads to more appropriate care, better communication between clinicians, added convenience for patients and, ultimately, reduced costs, then what’s not to love? That isn’t a rhetorical question. It’s just that I’m more on the patients’ side of this thing than the clinicians’, and as a patient I know health care is already far too expensive. For radiologists to eschew possible solutions because they might mean bringing home a smaller percentage of a salary that is already astronomical by most people’s standards, at a time when average Americans are spending 10% or more of their incomes for health coverage, just doesn’t seem right. We did some exploration of the integrated delivery model as it applies to radiology shortly after RSNA 2010 speaker Atul Gawande published his article “The Cost Conundrum” in the New Yorker. The easy explanation for Grand Junction’s success is economic incentives. The factor that’s harder to quantify is that Grand Junction seems to be a nice community where doctors honestly care about what’s best for their patients—financially as well as clinically. You can say, as one of the Grand Junction folks I interviewed did, that this model might be hard to reproduce in a bigger city. But, if money is removed from the equation, why should it be? Read Part Two Implementation, and the Advance Guard Christine Boehm Hawkins, is president, Jump Start Consulting, a full-service marketing consulting firm specializing in the health care/imaging industry; chawkins@jumpstartb2b.com, twitter@ChristyJHawkins