Nine Steps to Saving the Profession of Radiology

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Bruce HillmanNorman BeauchampOn November 25, at the 2012 RSNA annual meeting in Chicago, Illinois, three radiologists presented “Saving Our Profession: How Radiologists Can Thrive in the Era of Health Care Reform.” The suggestions offered by the presenters—Bruce Hillman, MD; Lawrence Muroff, MD; and Norman Beauchamp, MD—varied, but all centered on a common theme: that radiologists are facing the imperative to evolve before it is too late. Hillman, who is Theodore E. Keats professor of radiology and professor of health policy at the University of Virginia, notes that radiologists are currently experiencing the burden of success. “I think some of the problems we’ve run into are directly related to the very successful time we’ve had,” he says. These problems include declining reimbursement, as well as the need to adapt to emerging payment mechanisms. Hillman recommends three steps that radiologists should take to ensure the specialty’s successful future. Support Innovation Hillman observes that most of radiology’s runaway success in past years was owed to remarkable technological innovation. “This innovation is why we have prospered,” he says. “If we are to be successful as a specialty in the future, it will require at least the same level of innovation we’ve had in the past.” Toward that end, Hillman urges radiologists to donate 1% of their practices’ annual incomes to groups such as the RSNA’s Research and Education Foundation. “We need this money, and we need to support young researchers, going forward,” he says. Further, Hillman suggests that practices start participating in industry trials; he adds, “They pay much better than some of your clinical work.” Address Anti-imaging Bias Regulators and nonradiologist physicians often hold an anti-imaging bias—another legacy of radiology’s recent success, Hillman says. To address that bias, “We must improve the image of imaging by avoiding the appearance of self-interest,” he says. “We get out of this by making the patient our focus.” For instance, although some reactions to the radiation-dose issue have been overblown, the radiology community needs, he says, “to show we are reducing radiation dose where appropriate.” A deeper focus on outcomes is also warranted, he adds. Transition to Value Culture Speaking more broadly, Hillman notes that radiologists have been given incentives, so far, to increase productivity, sometimes at the expense of more important activities. “We’ve all lived and died by productivity,” he says, “but that’s going to change, and it will mean less time interpreting images and more time being a productive part of the health-care system.” This, he says, represents a needed transition from a culture that cherishes productivity above all else to one that puts value first. “We must take steps now to change our culture,” he says. Practice Smarter Muroff, president and CEO of Imaging Consultants Inc, outlines the threats that he sees radiology facing, including increased competition from nontraditional providers such as national practices and teleradiology companies. To address that problem, he recommends that practices take cues from what these groups provide, including 24/7 subspecialty coverage and quality measurement. “This is not business as usual,” Muroff says. “There are several companies out there that can—and will—take your contract.” To minimize the chances of being supplanted by these groups, Muroff notes, practices will have to decrease their emphasis on productivity. “The problem is that the very things that maximize productivity are the things that endanger a contract,” he says. “If you want to optimize your chances of retaining your hospital contracts, you have to provide better services than those nontraditional entities.” Aggregate Data Muroff also observes that hospitals increasingly will want to employ radiologists, making it easier for them to adapt to emerging payment methodologies (such as bundling). For that reason, he says, practices that want to remain independent will have to start aggregating data now to prepare themselves for handling new payment systems with the ease that hospitals will be demanding. “It’s clear practices are going to have to cope with a variety of alternative payment methodologies,” he says. “Preparation is going to be necessary, and many radiologists will not have the data they need to compete.” Diversify Income Opportunities Muroff’s third suggestion is that practices start looking into diversifying their income opportunities. “There is no question that the pie is going to be smaller in the future,” he notes. “If you really want to grow, you have to diversify. Great groups face problems, like everyone else; it’s just that they are better positioned to deal with those problems.” Form a Community Norman Beauchamp, MD, MHS, professor and chair of radiology at the University of Washington, emphasizes the importance of leadership within a hospital system. “You have to reinforce that your fates are inextricably linked,” he says. “The conversation has to be about the challenges that the hospital faces and how you will go about solving them together.” As part of this process, Beauchamp specifically recommends getting to know hospital leaders as individuals; for instance, at the University of Washington, Beauchamp started a jogging group that one of the hospital administrators attends, and the various department chairs also participate in a wine-tasting group. “You have to build in time to get to know your hospital partners outside of work,” he says. Leverage Clinical Decision Support Another key component of taking a leadership role will be more actively controlling the utilization of imaging, Beauchamp says. “What we need to be leaders in, now, is cost control (based on limiting access to studies when they are not value added),” he notes. “We have to be leaders in preventing inappropriate studies.” Specifically, Beauchamp recommends that radiologists introduce their organizations to Choosing Wisely [link:] and adopt leadership roles in any local outgrowths of the program. Focus on Outcomes Beauchamp calls for a significant investment in comparative effectiveness and outcomes research. “One of the challenges we have, in medicine, is that technology is vilified as a driver of cost,” he says. “We have to be doing more studies in comparative effectiveness.” He adds that there are opportunities for radiologists to partner with vendors to research the viability of new products: “We can help them see whether their technologies will improve quality or outcomes,” he says. In conclusion, Beauchamp echoes his copresenters in emphasizing the importance of patient focus to the specialty’s future. In the face of emerging challenges, he says, “The optimal response is to recognize the imperative to be better at meeting the needs of the patients and physicians we serve.” Cat Vasko is editor of and associate editor of Radiology Business Journal.