Declining Reimbursement, Other Trends Impacting Radiology Practice

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Eight trends are negatively impacting the practice of radiology, and radiologists are responsible for several of them.

That was the assertion of Lawrence Muroff, MD, CEO and president of Imaging Consultants in Tampa, Florida, and clinical professor of radiology the University of Florida and University of South Florida Colleges of Medicine. Muroff discussed these trends during a presentation at the 39th Annual Meeting and Exposition of AHRA: The Association for Medical Imaging Management, held last week in Grapevine, Texas.

Topping the list of trends is declining reimbursement, which according to Muroff could spark sharp increases in the equipment utilization rate, from 75% to at least 90%; as well as the consolidation of interventional radiology and CT codes. Declining reimbursement might also lead to the adoption of Medicare rates and congressional failure to permanently fix the sustainable growth rate (SGR) formula. The end-result, says Muroff: increased challenges in operating outpatient imaging departments.

Just as significantly, Muroff cites an unrealistic focus on productivity.He says attempts to compensate for declining reimbursement with increases in relative value unit (RVU) output, coupled with the widespread use of PACS (which further isolates radiologists from their colleagues), leads to a general erosion of relationships. This is followed by a subsequent perception among hospital administrators that radiologists are interchangeable, and eventual commoditization.

The "feds' love affair” with family practitioners, whom they consider underpaid and overworked while radiologists are just the opposite, ranks on the roster as well. "We have an image problem, ”Muroff states. "Why does that matter? Because [the U.S. Centers for Medicare and Medicaid Services (CMS)] plays a zero-sum game: If someone gets more, someone else gets less. And the favored target now is radiology.”

Moreover, Muroff asserts, the increasingly significant role played by radiologist assistants (RAs), radiology practitioner assistants (RPAs), and other "physician extenders" is further tightening the job market as some non-physician professionals fill the need for new radiologists and crowd out residents and fellows emerging from training. At the same time, he purports, the “new” generations of radiologists want both more time off and more money, which often buffers any motivation to really take ownership in a practice.

Meanwhile, turf battles continue to rage, and hospital administrators are growing more demanding. "Why should radiologists believe that other specialists won't try to emulate the success of cardiologists and vascular surgeons [in taking over procedures]?" Muroff asks. "It's a slippery slope, and just because radiologists have been lucky so far doesn't mean that they'll be lucky forever."

He adds that a growing volume of radiologists will receive “pink slips” from their contracted hospitals because the latter are weary of fielding complaints from referring physicians about radiology service. They also do not look kindly on competition from radiology groups, and they either desire more control or believe the group in question is too small to provide the necessary subspecialty expertise.

Finally, Muroff notes, cash-starved academic departments will be forced to compete in the private sector for specialty reads, teleradiology coverage, or even entire hospital contracts. "Private practice does not have a lock on hospital contracts just because that's the way it has been in the past," he says. "We are just starting to see competition from academia, and it will only intensify."

To learn about the additional, scarier “unholy four” trends Muroff warned attendees will surface over the next few years, see tomorrow’s Newswire.