Jonathan W. Berlin, MD, MBA, clinical associate professor of radiology at University of Chicago Pritzker School of Medicine, discusses five ways radiology will change over the next several years.
1. Radiologists will work harder. According to Dr. Berlin, recent years have seen an increase in the complexity of radiology procedures and services. As the complexity of the procedure mix goes up, so do the expectations of radiologists and therefore the radiologist workload. "The work of a radiologist has turned toward more complex procedures, and interpretations need to be more immediate than they did in the past," he says.
If workload goes up but reimbursement goes down, compensation could be adversely affected. According to MGMA's Physician Compensation and Production Survey: 2010 Report Based on 2009 Data, diagnostic-invasive radiologists earned an average of $479,896 in 2009, while diagnostic-noninvasive radiologists made an average of $515,354. That compensation could potentially stagnate as increased caseload and decreased reimbursement work against each other.
2. Radiologists, like all physicians, will be tasked with reducing costs. Most medical specialties are experiencing decreased reimbursement, and radiology is no different, Dr. Berlin says. As technology advances, providers are faced with a situation where they must cut costs in order to be able to perform up-to-date procedures. "If you look at the short-term, radiologic practices might be able to defer radiology hires or purchases of new equipment," he says. "The equipment they buy may not be the most expensive model, or it may be leased instead of bought. However, in the long term, some of these cost-cutting measures may be difficult to sustain permanently."
Information technology may assist radiologists in cutting costs by giving providers the ability to do work for multiple hospitals from one setting. Radiologists will not be able to read cases faster — in fact, Dr. Berlin says they may take longer as films become more complex. But radiologists who work at a number of different imaging centers may be able to read films from different sites using an electronic system, which improves access and efficiency.
3. Greater attention will be paid to negative exams. Dr. Berlin says there are currently a lot of forces at work to decrease medically unnecessary imaging volume. The problem lies with differentiating tests that are medically necessary and unnecessary. "The majority of [doctors] do make an effort to order medically necessary tests. Of course, there are some well-documented exceptions to this, such as self-referral in some cases, but in most cases, I think most doctors are trying to do the right thing," he says. "There are a very large number of reasons why imaging has gone up, and it depends how 'medically unnecessary' is defined." He refers to the Dartmouth Atlas of Health Care: Regional Disparity in Medicare spending, a map that shows how Medicare spending differs across the country.
"Policymakers refer to this map a lot, saying, 'Why does Medicare spend significantly more per beneficiary in one portion of the country?'" he says. "[They might interpret that data] to mean medical care is unnecessary in places where they're spending three times as much." But he says that solely interpreting the data in that manner may ignore important confounding variables, such as limited access to primary care physicians or poor eating or health habits. "It's a complex thing," he says. If policymakers and physicians focus their energy on decreasing negative exams rather than decreasing Medicare spending, they will be able to target populations for whom exams are ordered unnecessarily, rather than populations who actually need more healthcare spending.
4. Communication with ordering providers will increase. In order to tackle the problem of negative exams, Dr. Berlin says radiologists need to work with ordering physicians to standardize ordering protocols. "We really shouldn't have instances where 90 percent of the radiologic exams a particular physician orders for a specific indication are negative, and then in a neighboring practice, there's another physician ordering radiologic exams on a similar patient population for the exact same clinical indication, and only 3 percent of those radiologic exams [he or she orders] are negative," he says. Standardizing ordering protocols means better communication between radiologists and ordering physicians, a task he says has already begun.
"I think individual radiologists are rising to the task of addressing medically inappropriate imaging to some extent already," he says. "In the future, however, radiologists are going to need to be even more cognizant of the need to maximize clinical efficacy of the radiologic exams and work even more diligently with ordering physicians to make sure patients get appropriate exams." He says appropriate exams can differ significantly based on the patient. Because radiologists are so experienced with imaging exams, ordering physicians should solicit advice from radiologists to determine which test is needed.
5. People will become more cognizant of radiation dose. Dr. Berlin predicts that over the next several years, patients and providers will become even more cognizant of radiation dose. "I think the amount of radiation delivered per CT will go down, and vendors are making significant strides toward achieving this goal," he says. "Radiologists can also play an important role in making sure that exams are dong appropriately. For example, by insuring that the correct protocol is used for the correct patient, the need to repeat technically inadequate exams can be minimized, and radiation dose can be decreased."
He says that an awareness of radiation doses doesn't necessarily mean a demonization of radiation. "On an individual basis, the risk of not diagnosing a clinically significant and potentially life-threatening finding will likely outweigh the risk of the diagnosing procedure in the majority of cases," he says. He points out that a healthy asymptomatic population is very different than a population of patients with clinically suspected abnormalities for whom radiation is necessary to diagnose a serious condition. "It's very hard to say that patients with suspected clinically significant abnormalities shouldn't be exposed to a certain amount of radiation to make the diagnosis," he says. "Instead, you want to give the least amount of radiation you can to make the diagnosis and do the appropriate exam."
Read more on physician practice:
-Pennsylvania's Wilkes Barre General Acquires Large Group Practice
-CMS Launches First Phase of Physician Compare Website
-CDC: Half of Office-Based Physicians Use Partial or Full EMR
1. Radiologists will work harder. According to Dr. Berlin, recent years have seen an increase in the complexity of radiology procedures and services. As the complexity of the procedure mix goes up, so do the expectations of radiologists and therefore the radiologist workload. "The work of a radiologist has turned toward more complex procedures, and interpretations need to be more immediate than they did in the past," he says.
If workload goes up but reimbursement goes down, compensation could be adversely affected. According to MGMA's Physician Compensation and Production Survey: 2010 Report Based on 2009 Data, diagnostic-invasive radiologists earned an average of $479,896 in 2009, while diagnostic-noninvasive radiologists made an average of $515,354. That compensation could potentially stagnate as increased caseload and decreased reimbursement work against each other.
2. Radiologists, like all physicians, will be tasked with reducing costs. Most medical specialties are experiencing decreased reimbursement, and radiology is no different, Dr. Berlin says. As technology advances, providers are faced with a situation where they must cut costs in order to be able to perform up-to-date procedures. "If you look at the short-term, radiologic practices might be able to defer radiology hires or purchases of new equipment," he says. "The equipment they buy may not be the most expensive model, or it may be leased instead of bought. However, in the long term, some of these cost-cutting measures may be difficult to sustain permanently."
Information technology may assist radiologists in cutting costs by giving providers the ability to do work for multiple hospitals from one setting. Radiologists will not be able to read cases faster — in fact, Dr. Berlin says they may take longer as films become more complex. But radiologists who work at a number of different imaging centers may be able to read films from different sites using an electronic system, which improves access and efficiency.
3. Greater attention will be paid to negative exams. Dr. Berlin says there are currently a lot of forces at work to decrease medically unnecessary imaging volume. The problem lies with differentiating tests that are medically necessary and unnecessary. "The majority of [doctors] do make an effort to order medically necessary tests. Of course, there are some well-documented exceptions to this, such as self-referral in some cases, but in most cases, I think most doctors are trying to do the right thing," he says. "There are a very large number of reasons why imaging has gone up, and it depends how 'medically unnecessary' is defined." He refers to the Dartmouth Atlas of Health Care: Regional Disparity in Medicare spending, a map that shows how Medicare spending differs across the country.
"Policymakers refer to this map a lot, saying, 'Why does Medicare spend significantly more per beneficiary in one portion of the country?'" he says. "[They might interpret that data] to mean medical care is unnecessary in places where they're spending three times as much." But he says that solely interpreting the data in that manner may ignore important confounding variables, such as limited access to primary care physicians or poor eating or health habits. "It's a complex thing," he says. If policymakers and physicians focus their energy on decreasing negative exams rather than decreasing Medicare spending, they will be able to target populations for whom exams are ordered unnecessarily, rather than populations who actually need more healthcare spending.
4. Communication with ordering providers will increase. In order to tackle the problem of negative exams, Dr. Berlin says radiologists need to work with ordering physicians to standardize ordering protocols. "We really shouldn't have instances where 90 percent of the radiologic exams a particular physician orders for a specific indication are negative, and then in a neighboring practice, there's another physician ordering radiologic exams on a similar patient population for the exact same clinical indication, and only 3 percent of those radiologic exams [he or she orders] are negative," he says. Standardizing ordering protocols means better communication between radiologists and ordering physicians, a task he says has already begun.
"I think individual radiologists are rising to the task of addressing medically inappropriate imaging to some extent already," he says. "In the future, however, radiologists are going to need to be even more cognizant of the need to maximize clinical efficacy of the radiologic exams and work even more diligently with ordering physicians to make sure patients get appropriate exams." He says appropriate exams can differ significantly based on the patient. Because radiologists are so experienced with imaging exams, ordering physicians should solicit advice from radiologists to determine which test is needed.
5. People will become more cognizant of radiation dose. Dr. Berlin predicts that over the next several years, patients and providers will become even more cognizant of radiation dose. "I think the amount of radiation delivered per CT will go down, and vendors are making significant strides toward achieving this goal," he says. "Radiologists can also play an important role in making sure that exams are dong appropriately. For example, by insuring that the correct protocol is used for the correct patient, the need to repeat technically inadequate exams can be minimized, and radiation dose can be decreased."
He says that an awareness of radiation doses doesn't necessarily mean a demonization of radiation. "On an individual basis, the risk of not diagnosing a clinically significant and potentially life-threatening finding will likely outweigh the risk of the diagnosing procedure in the majority of cases," he says. He points out that a healthy asymptomatic population is very different than a population of patients with clinically suspected abnormalities for whom radiation is necessary to diagnose a serious condition. "It's very hard to say that patients with suspected clinically significant abnormalities shouldn't be exposed to a certain amount of radiation to make the diagnosis," he says. "Instead, you want to give the least amount of radiation you can to make the diagnosis and do the appropriate exam."
Read more on physician practice:
-Pennsylvania's Wilkes Barre General Acquires Large Group Practice
-CMS Launches First Phase of Physician Compare Website
-CDC: Half of Office-Based Physicians Use Partial or Full EMR