Jonathan Berlin, MD, on Decommoditizing Imaging
imageStat Readers, I have but one word for you: SNOW! You thought I was going to say something else, didn’t you? “Cloud,” “tomo,” “personalized” . . . well, sorry. I live in LA; snow is really exciting. But that’s not the reason for this entry, I just had to share. The real reason is the terrific session I attended this morning on “Addressing Threats to Radiology,” kicked off by the wonderful Jonathan Berlin, MD, with a discussion of commoditization in imaging. Commoditization, he explained, happens when the only way customers can differentiate between products in a given category is price – and it’s happening to imaging. “If you compete on price alone,” he warned, “you wind up with three options: earn less, work harder for the same pay, or work harder to earn less.” But it’s not all bad news. Berlin believes imaging can become decommoditized, the way, for instance, water was decommoditized with the advent of the bottled water industry, or carrots were decommoditized by packaging them pre-peeled and washed in convenient bags. (Don’t know what he’s talking about with that last example? Do yourself a big favor and check out Re-introducing value to radiology will require hard work, Berlin said, but it’s not impossible. The key is to prove the same services as teleradiology companies – subspecialization, 24/7 coverage – with the added benefits an onsite radiologist can provide, including pre-service work such as determining an exam’s appropriateness and ensuring it’s done properly. “Focusing on interpretation only commoditizes our job,” he said. What’s more, with changes to payment mechanisms likely on the way, potentially including ACOs or bundled payments, radiology has an opportunity to get in on the ground floor, demonstrating to hospital leadership its ability to lower costs while increasing quality. After all, Berlin said, “How can we share in the cost-reduction benefits if we’re not participating in reducing costs?” Berlin suggests that radiologists work on three things that could help decommoditize the profession: increasing evidence-based research into outcomes; increasing education in areas of exam appropriateness; and increasing education in exam effectiveness. “By blowing it off,” he warned, “we expose our own uncertainties regarding the significance of findings. We drive up cost, drive down reimbursement, and abdicate a key responsibility of our field.” But by taking an active role as stewards of imaging services, he concluded, “Radiology is at the table rather than on the menu.”