The Radiologist’s Changing Role: A Q & A With Frank Seidelmann, DO
The radiology industry is undergoing tectonic changes as a result of declining reimbursements, ever-improving technology, and the emergence of innovative new delivery models. Though much has been written about the impact of these changes on the industry as a whole, the role of the radiologist in this evolving marketplace is often overlooked. Frank Seidelmann, DO, chair of the board and clinical director of neuroradiology at Radisphere National Radiology Group, Beachwood, Ohio, discusses with ImagingBiz how the role of the radiologist has evolved and predicts what today’s radiologists-in-training will seek from practices in the future. ImagingBiz: We’ve seen some rapid evolution in radiology delivery in the past couple of years. What forces are behind these changes in the industry? Seidelmann: I’ve practiced radiology for 35 years, so I’ve lived through a lot of changes in the industry. When I trained, in the 1970s, radiology was bone and barium: There were vast areas of the body we couldn’t begin to evaluate that, today, we can image down to the molecular level. As imaging capabilities have so vastly increased, the knowledge base of radiology has exploded, as have the demands of referring physicians in terms of expertise, volumes, communication, and timeliness of reports. In the 1980s and going into the 1990s, subspecialization developed, and radiologists started having issues with medical staffs at hospitals requesting neuroradiologists, musculoskeletal radiologists, and so forth. The hospital demand for radiology services changed dramatically at that point. We saw the advent of new technology, and with the development of PACS, we gained the ability to move images and provide final interpretations without being geographically bound. It changed the whole practice. Outpatient imaging is the largest profit driver for community hospitals now, and radiology is a key influence in length of hospital stay; it’s important that radiologists make the correct diagnosis as quickly as possible, without unnecessary testing, for the financial health of patients and hospitals. All of this underscores how the demand for radiology has changed at the community hospital, but for the most part, radiology groups have been slow in changing; there are 3,400 groups in the country, of which 2,500 have 10 radiologists or fewer. It’s going to be difficult for these kinds of groups to continue to provide their services as referrers, patients, and payors continue asking for more value from radiology. The traditional delivery model is going to struggle with all the demands placed on it now. The supply side of radiology needs to change to meet the rapidly changing demand. ImagingBiz: Where do you believe the radiology practice will be in five years? Seidelmann: Whatever the delivery model is going to be, it will have to provide a number of elements to survive. There’s going to be an increased demand for subspecialization, an increase in the volume of studies, and declining reimbursement. There’s also an increased demand, from both hospitals and payors, for defined quality measures and transparency in areas such as peer review, turnaround times, and consultation-report times. I think the per-unit reimbursement will decline dramatically and will be replaced with some kind of quality measure, so that better radiologists will be paid more. The only groups that will be able to deliver this level of care will be larger groups that make a significant investment in technology and human resources. We will have to do more—and do it better. ImagingBiz: Are radiologists moving away from working as part of traditional groups as a result of these changes? Seidelmann: By the nature of their training and what they want to do clinically, radiologists are tending to subspecialize more; radiologists coming out of training are looking for the types of models or radiology organizations that will allow them to practice their subspecialties and won’t force them into the full gamut of radiology services. The traditional partnership structures of most radiology groups also are based on tenure; they’re not meritocratic, in the sense of rewarding subspecialty radiologists and their productivity. Today’s radiologists want to practice in their fields, to do it very well, and to continue to train and learn with radiologists similar to themselves in experience. They want to maintain their incomes, enjoy their lifestyles, and get paid for the value they create. The traditional models will have difficulty providing this, so radiologists are going to be moving toward joining larger organizations. ImagingBiz: How is the role of the radiologist evolving under these new models? Seidelmann: Radiologists are going to have to get much more involved with their clinical colleagues. They’ll no longer be able to remain in an isolated environment. They’re going to have to function as valued consultants, advising clinicians and being involved in day-to-day care. That will require the ability to communicate, to consult, and to share images with referring physicians, wherever they are and at any time. They will also have to become actively involved in quality assurance and peer review, so they can continually improve. ImagingBiz: What should today’s radiologists look for in a practice? Seidelmann: I believe they need to look for scale. Organizations will have to be of a critical size to be competitive in the marketplace. They should look for groups that are invested in technology, that are committed to client service, and that are committed to quality measurements and programs. They should look for practices committed to education and collaboration, and they also should be looking for meritocratic compensations structures. They should be looking for organizations with strong clinical leadership and a commitment to delivering subspecialty care. ImagingBiz: How has Radisphere evolved, in recent years, to meet the changing needs of radiologists? Seidelmann: I founded this practice as a new model to meet the changing needs of community hospitals and radiologists. It began, in the early 2000s, as Franklin and Seidelmann, which was dedicated to providing daytime subspecialty services to outpatient, nonacute centers. Once we evolved into a complete service for community hospitals, we changed the name; along the way, we’ve built one of the largest networks of subspecialty radiologists, and that allows the radiologists in our organization to read only studies within their subspecialties. We built our own internal, final reads ED coverage that is 24/7. We've invested in technology to support our radiologists and the hospitals we serve. We’ve developed a platform that allows for automatic peer review, and we share that information with our radiologists and hospitals so that we’re accountable. We have contractual commitments to our hospitals for turnaround time and critical findings, we measure time to consultation, and we’re transparent with all our results. ImagingBiz: How does the practice’s structure benefit radiologists? Seidelmann: We’ve organized ourselves similarly to academic centers; for each area of subspecialty we have clinical section chiefs who work with all radiologists in their areas to maintain high quality. We have department chairs and regional department chairs who can work with hospital administration to make sure we’re fulfilling their leadership needs. When radiologists in a given subspecialty have difficult studies, they have other specialists with whom they can share the case and collaborate; this can often be difficult in other types of groups. Some of the things I’ve touched on are very challenging for traditional radiology groups: developing robust IT and network solutions and proprietary software solutions, in addition to providing the necessary consultative services to hospitals. It’s very difficult for radiologists to get their jobs done as it is, and demands are being placed on them to be more efficient, while hospitals are looking for a more extensive array of services. Understanding their departments in greater depth, tracking referral patterns, and controlling utilization: These are services hospitals want that traditional radiology groups cannot begin to offer. So it is important that as radiology organizations grow, they make significant investments in improving radiologist productivity, delivering quality, and supporting hospitals and medical staffs. Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.