Just Following Orders
Curtis Kauffman-PickelleMy column last month, on accountable-care organizations (ACOs) and the same-old, same-old business model, generated some interesting responses. One, in particular, got me thinking about the evolution of radiology and where the profession finds itself today, relative to the quickly changing integrated-delivery models being discussed nationally. A reader responded that “the old paradigm in which radiologists served as order takers, doing what they are instructed to do by referring physicians” needs to change to a new model in which “radiologists are active participants in a real-time diagnostic process.” In trying to control the costs of health care, payors will no longer accept the notion that the radiologist is simply following orders, especially as at least 30% of those orders are, in their estimation, unnecessary. As this reader rightly pointed out, radiologists will increasingly be charged with determining the appropriate imaging modality and procedure. If payors are going to continue to accept the high cost of diagnostic imaging as a percentage of total health-care spending, they will need justification. That justification can only come in the form of proactive radiologists, who (as my respondent noted) “will need to become far more involved in the development of clinical protocols and care guidelines, [with] their performance increasingly measured against these guidelines.” Regarding a discussion about how active radiologists should be in helping to define the proper role for radiology within an ACO or other integrated-delivery network structure, he writes, “Radiologists should embrace this new role, rather than fight it. Protocols are an inevitable consequence of the ACO process, and someone will develop those guidelines. If radiology sits on the sidelines, the consequences will not be pleasant.” This is where we find ourselves at the beginning of 2012: Radiology is expensive. Lots of radiology exams are being done. Nobody can really demonstrate that other health-care costs have been offset by increasing numbers of diagnostic-imaging studies. Legislators, regulators, payors, and radiology benefit managers are looking for a pathway to controlling utilization and reimbursement. Referring physicians are looking for diagnostic partners—and a great deal of help in understanding the proper role of diagnostic imaging in the lives of their patients. I think my reader correspondent got it exactly right. We have been writing about the coming change in the fundamental model of radiology for some time now, and to a greater or lesser degree, radiologists have mused about what they see as shifting support, or a basic lack of understanding of the contribution that they make to the overall health-care delivery system. To get the respect, attention, satisfaction, and rewards that accompany being integral to any enterprise, it is critically important that one step up and commit 100% to being an agent of change, someone of significance, and someone who will truly add value to the process. You won’t get to that point by being an order taker. Get into the arena and be a part of what radiology can and should become—what it has, in fact, become in certain role-model practices around the country. Be a leader, and don’t settle for the mediocrity that accompanies the just-following-orders mentality. There’s much more to life than tons of vacation—and those who pay the bills know it. Curtis Kauffman-Pickelle is publisher of ImagingBiz.com and Radiology Business Journal, and is a 30-year veteran of the medical-imaging industry. He welcomes your comments at ckp@imagingbiz.com.