Fight or Flight?

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Cat VaskoA new year is upon us, but in the radiology community, there is little to feel optimistic about this January. The fiscal-cliff negotiations came and went with no attention to the Multiple Procedure Payment Reduction in the 2013 Medicare Physician Fee Schedule, but the utilization-rate assumption for imaging equipment was raised to a perilous 90%. The sustainable growth rate was, once again, addressed with a one-year delay instead of a permanent fix, meaning that we’ll all be biting our nails again in December 2013.

It would be easy, under these circumstances, to succumb to feelings of despair. It seems that the government is not done targeting radiology for health-care cost containment—not by a long shot—despite mounting evidence that it was self-referred (and not radiologist-performed imaging) that contributed to escalating costs in the first place. There are two ways to respond to this continuing onslaught, and they can be distilled down to basic human survival instincts: fight or flight.

I recently exchanged email with a radiologist reader who came down rather dramatically on the flight side, threatening that the decline in payment (and, perhaps, respect) would lead to fewer intelligent, driven individuals choosing the field. Why would they, he implied, when they can make more money from their abilities elsewhere?

I was reminded of a session at a recent conference during which the presenter attempted to contextualize the lack of popular support for imaging by explaining to the audience how little money most U.S. households have. I am not quoting directly, but I recall him clarifying that most people have very little (if anything) set aside for retirement and that most cannot afford to take more than one vacation a year. These points were not met by stunned exclamations from the audience, but the fact that they needed to be made in the first place is telling.

This January, the writing is—more than ever before—on the wall: If you are in radiology only for the money, you are in the wrong business. Not only will your reimbursement continue to decline until it reaches a level closer to that for primary care, but emerging payment methodologies will force you to be more patient centered or face further financial penalties. We can argue about whether this is appropriate or fair until we are blue in the face, but it won’t change the facts. The question, now, is not whether these changes are fair. It is what we are going to do about them.

Will your response to an increasingly tough regulatory and reimbursement environment be flight, or will it be to fight? By fight, I don’t mean on Capitol Hill; while advocacy there is critical, what we are advocating must also change. We have to become our own advocates, not just in Washington, but in our communities—taking the lead to make patient care more effective and cost efficient. This is a natural role for radiology; as one of two diagnostic specialties, radiology can (and should) coprovide the gateway to better treatment planning and execution.

It is a role that we sacrifice, however, when we tarnish our image in the eyes of patients and our fellow providers by focusing our efforts not on improving care, but on making money. We have to fight for what is best for patients now and trust that the money will follow—because we have already seen the consequences of being perceived as doing the opposite.

Cat Vasko is editor of and associate editor of Radiology Business Journal.