Whatever form the Patient Protection and Affordable Care Act (PPACA) may take—and we are, of course, in an election year—a confluence of factors conspires to keep radiologists in demand for the foreseeable future, says Brian Baker, President of the Franklin, TN-based Regents Health Resources.
“There will be plenty of work if you want it,” Baker says. “We’re going to need the leadership and involvement of the radiologist community to help us define how to accommodate patient access to health reform volume.”
Among the key factors driving demand...
Retirement. According to Baker, a study done by Staff Care in late 2011 revealed about 46% of radiologists are nearing retirement age--56 and older. Without additional physicians to take their places, patient access to quality radiologists could become something of note amid compounded growth expectations.
Technical and Process Advancements. As processes and technology continue to advance, “radiology subspecialties will see a greater reliance on their capabilities,” Baker says.
Competition. As hospitals become more and more competitive for healthcare dollars in general, Baker believes they’ll work harder to manage the ways that radiology practices contribute in everything from reports to costs to staff participation.
“Hospitals want radiologists more involved and they’re looking for ways to achieve that,” he says. “Whatever radiologists can do to make themselves more efficient and replicate their services will be key levers to sustainability.”
Data. Imaging utilization and spending is down even as spending on other, non-imaging services climbs, which helps to put radiologists in the catbird seat—if news of the real numbers circulates enough.
Baker cites MITA figures on the 13 percent decline in per-beneficiary spending on imaging services since 2006 as well as the 3 percent utilization decline it observed in 2010.
The inverse of that, he says—again, according to MITA—is that non-imaging services as a percentage of Medicare spending have increased 20% since 2006, and non-imaging service utilization increased 2% in 2010. This clearly points to cost drivers other than imaging impacting Medicare.
A study done by Regents on PPACA removed the Medicare patients from the utilization equation and still found that imaging use is expected to increase nearly 14 percent nationally “when an estimated 31 million formerly uninsured people…join the ranks of the insured” under health reform.
“In order for us to ensure that the right people are getting the right exam on the right machine with the right protocol, we need to manage utilization better than we do today,” Baker says. “Notice I did not say, steer, deny, or refuse. Imaging is a significant cost and time efficient contributor to the patient care process and its use should be promoted…its appropriate use.”
Today “we only have half the feedback loop,” he says: for example, a patient complaining of a headache gets an MR study; it is reviewed by a radiologist and the results are transmitted back to the referring physician. The radiologist never hears back from the patient or the referring physician unless it goes to a peer review. Closing this loop is a missing step that is desperately needed, Baker says.
To better manage appropriate utilization, we first “need to understand the patient condition that drove the need for an exam, the exams and protocols that were performed, the radiologist interpretation, and the final outcome of the patient, so we can learn from the procedures that were performed and the final results.
“Today the only way radiologists get feedback is if that exam gets chosen to be peer-reviewed,” he says.
“The inappropriate use that has been happening for so many years is driving the perception that imaging is over-utilized. Anecdotal reports indicate this may be impacting the ability of some patients to get exams.
“Access is not an issue today; it may be tomorrow,” Baker says. “To be able to manage and accommodate the utilization that’s projected, we need to get more specialized, better informed, and better organized around data as a national health system.”
Curious about 2015 when, if PPACA stands, as many as 31 million formerly uninsured people may be required to get health coverage? Read "Forecasting Imaging Use Under Health Care Reform" .