Four Factors Shaping Imaging’s Future
Every year since 2001, the ACR® Forum has gathered experts from within and outside radiology to discuss issues facing the specialty. The theme for the 12th Annual ACR Forum, held in June 2012 in Reston, Virginia, was Radiology in 2022, and participants (including the publisher of ImagingBiz) were asked to look ahead to anticipate the challenges that the profession will face in the coming decade. Forum participants also developed a list of consensus recommendations to help grow and strengthen the field. The four central, interrelated issues that the participants identify as being critical to the future of the field are outlined in a January 2013 article¹ in Journal of the American College of Radiology: JACR. They are health-care reform and future payment models, research and innovation, patient-centered radiology, and information management. Health-care Reform and Future Payment Models Modern health-care reform has revolved around cost containment, since spending has increased dramatically in recent years. Various proposed payment models range from budget-based capitation to fee-for-service payment. Many physicians, including radiologists, prefer traditional fee-for-service payment because of its familiarity and low financial risk. The fee-for-service model is susceptible to abuse, however, since its reimbursement incentives encourage providers to deliver more care than is necessary (leading to overutilization). Alternatively, global capitation reduces costs, but shifts risk to providers, encouraging them to deliver less care in order to maintain viability. With poor risk adjustment for patient populations, providers can expose themselves to heavy financial losses. As a result, this model typically limits consumer choice. An ideal model would contain costs, improve access, provide better care coordination, and increase quality. The Patient Protection and Affordable Care Act proposed a bundled-payment model—a compromise between fee-for-service payment and full global capitation. Payments are based on episodes of care; this requires greater coding precision, with reimbursement tied more closely to improved outcomes. To prepare for future payment models, the forum’s participants suggest that the ACR establish various systems to support, educate, and prepare radiologists for possible changes. The ACR should track, measure, and record data that can demonstrate imaging’s value to health care. This requires better coding procedure, more studies, and more robust tools and data-collection methods. Research and Innovation Over the past 40 years, new technologies and diagnostic modalities have emerged in ultrasound, CT, PET, and MRI, reducing the need for invasive procedures such as exploratory surgery. Reductions in imaging reimbursement, concern over radiation safety, and lack of data demonstrating imaging’s contribution to improved health outcomes have stalled imaging growth and innovation in the United States, however. Imaging research has shifted toward quantitative imaging because of precision medicine, an individually customized approach to patient treatment. According to the principles of P4 medicine (as established by Leroy Hood, MD, PhD), radiology must be predictive, preventive, personalized, and participatory. This implies greater interaction with patients, taking into account their medical histories and preferences. New radiotracers and imaging devices that are able to perform studies at the molecular level will contribute to precision medicine by offering a more complete picture of the patient, and they will demonstrate imaging’s contribution to improved health outcomes. For vendors and manufacturers, the success of future imaging technology depends on three factors: benefits to providers and patients; a favorable cost–benefit ratio, compared with current options; and the total cost that society is willing to pay (and can afford). Forum participants advise the ACR to cooperate more closely with research organizations such as the Patient-Centered Outcomes Research Institute and to establish guidelines for comparative-effectiveness research. In addition, the ACR should explore and outline the concept of precision medicine and articulate how it can apply to radiology. Patient-centered Radiology Radiology must adapt to a new patient-centered environment by giving patients the information needed to make informed decisions, by delivering the correct exam as safely as possible, by effectively communicating exam results, and by offering a fair price. Patient-centered radiology requires greater transparency and will make information about the qualifications of physicians readily available. Imaging reports have to be formatted for easy comprehension and accessibility for patients, and improved decision support will help referring providers select the appropriate imaging studies. As medical imaging transitions to an information focus, use of local and global databases will increase, and aggregated information networks will allow radiologists to play a greater role in interdisciplinary teams. With increasing competition, radiology practices must track and measure their performance in ways critical to addressing patient concerns and operational defects. The forum advises the ACR to develop support tools for better communication with patients, to promote new guidelines for communication, to teach improved business analytics, to cooperate with patient-advocacy groups, and to create reporting templates for patients. Information Management IT and information management are playing bigger roles in health care thanks to initiatives such as the meaningful-use program, which is driving the adoption of electronic medical records. Once health-care data are fully digitized, data mining can be used to unearth trends and patterns that might be crucial to imaging’s future. Electronic health records will give radiologists access to patients’ histories, leading to improved individual diagnoses and greater specificity in radiology reports through the integration of contextual data. Radiology reports will interact with other existing databases, providing point-of-care physicians with more information on patients and providing a reference to population data on relevant medical conditions. Overutilization will continue to be a concern, but advanced informatics will reduce inappropriate imaging growth. Decision support for referring providers and radiologists will reduce variability in reporting and cut down on unnecessary additional imaging. Appropriateness criteria will be implemented into order-entry decision-support systems for imaging and will increase efficient imaging utilization. The forum recommends that the ACR establish infrastructure for integrated databases, encourage data mining to generate new knowledge, support informatics-training programs, integrate ACR appropriateness criteria into decision-support systems, and develop a central database of key performance measurements and benchmarks for clinical practice. The 2012 ACR Forum acknowledges that radiology faces many challenges in the coming years. These challenges, however, also present opportunities to prove, through extensive research and improved data availability, that imaging is a vital component of health care. Thanh Le is a news editor for ImagingBiz.