Four Factors Shaping Imaging’s Future

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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