We Are All Patient Facing Now

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Cat VaskoIn writing, thinking, and speaking about the challenges of preventing the commoditization of radiology, an oft-cited issue is the fact that many radiologists are not patient facing in their roles. The radiologist’s primary product is the report, and the report is meant for the referring physician. As a result, preventing the commoditization of imaging through increased patient interaction has been the clarion call of several thought leaders in the field and the subject of an RSNA campaign, although where already-beleaguered radiologists are supposed to find the necessary time is a subject of some debate. As many battles are, this one will be fought on multiple fronts, only one of which is striking that magical balance between profitable practice and patient satisfaction. I don’t think that a day goes by when I don’t spot a link in my Facebook newsfeed that I am dying to discuss in this space. These links almost always deal with the criminally high cost of medical care in the United States, and they are posted by friends who work well outside our field and whose understanding of how the health-care system operates is limited. Whether you are aware of it or not, there’s a public-relations battle brewing between health care and its increasingly educated and sophisticated patients—and health care is losing. My most recent piece of evidence is a June 1 New York Times article¹ entitled “The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures.” If the headline alone doesn’t strike fear into your heart, the infographic that immediately follows should: it compares the average US price with average prices in other developed nations for five procedures, including angiograms, hip replacements, and MRI exams. If your front desk has not yet received an angry inquiry about why that MRI exam cost four times as much as it would have in the Netherlands, you can probably expect that question soon. I’m lucky to live in Los Angeles, California, where it’s possible to comparison shop among legions of excellent physicians until I find one I like—and what always distinguishes those I prefer from those I never return to again is their candor about cost. Even when specific numbers come down to the vagaries of payors, the physicians I patronize give me a range I can expect from my bill, and they are happy to explain the risks of not having that $300 follow-up ultrasound, for example. There’s no gentlemen’s agreement that cost is irrelevant when hundreds or thousands of dollars are on the line: I expect to be informed fully about my options, just as I would be when buying a new computer or having something repaired in my home. I’ve said before—but cannot emphasize enough—that finger-pointing regarding who is responsible for these bills is irrelevant to patients. In the new world of consumer-driven care, that also means that it should be irrelevant to providers of imaging services. We cannot fail to address the issue of cost on the grounds that it’s not really our responsibility or problem. What we can do is empower patients with the information that they need to understand the relevance and necessity of the procedures that we perform, particularly when recommending potentially costly follow-up studies. That’s the kind of meaningful patient interaction that reforms the image of health care, even in the face of an onslaught of negative public opinion. Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.