4 Current Radiology Trends

Healthcare costs across the nation are frequently described as unsustainably high, and advanced imaging tests and radiologists have been targeted as contributing to the problem.

"In radiology, there is significant variance in clinical protocols and contextual measurement of quality," says Naseer Hashim, chairman and CEO of Imaging Advantage, a leading provider of technology-driven hospital-based radiology solutions. "This is why we are seeing ever more prevalent headlines on patient radiation exposures and imaging abuse, and how that abuse contributes to the high cost of healthcare."  

Mr. Hashim believes the radiology profession is at a crossroads. "On the one hand, the work of radiologists remains as important as ever to hospital-based medicine. Radiology touches nearly every patient and a robust modern imaging program is crucial to creating a definitive, effective and efficient care plan," he says.

On the other hand, a number of trends are converging that diminish the economics of the profession. Here, Mr. Hashim elaborates on four of those.

1. Commoditization. The modernization of the practice of radiology — such as the use of after-hours final-reads teleradiology, which makes it difficult for radiologists to personally interact with patients and ordering physicians — has isolated radiologists, intensified pricing competition and fostered the perception that the work done by radiologists is a commodity.

Additionally, the increasing popularity of accountable care organizations and risk sharing models contributes to the commoditization of the specialty.

"This shift in thinking turns a hospital's 'purchase' of radiology services into a price-based decision," says Mr. Hashim. "It leads to a race to the bottom and attrition of the best doctors. To address the situation, we [at Imaging Advantage] ask our hospital partners to consider an alternative: What if radiology could actually become the crucial fulcrum for delivering system-wide clinical and economic improvements? In essence, we turn the dialogue on its head."

2. Employment models. Following the national trend in many physician specialties, increasing numbers of radiologists are giving up independent practice to become employees of hospitals and health systems. Mr. Hashim cites several reasons for the trend, including a perception that employing radiologists is more economical or a better way to create alignment, particularly where hospitals have been subsidizing radiology or the hospital's radiology group has been operating a competing imaging center.

"Often, a hospital's decision to adopt an employment model is presented to radiologists as part of a larger strategy around shared savings models, such as ACOs," says Mr. Hashim. "If you actually unbundle the complex economics associated with employing radiologists, the unit cost per RVU is higher than a subsidized group model, and significantly higher than the Imaging Advantage model. We have been deploying a new strategy at a number of systems which not only rewards radiologists for better patient care and outcomes — which is what radiologists clearly want — but reduces costs and expands hospital margins. It makes a strategic partnership model, as opposed to an employment model, the least-cost option to the hospital."

3. Decreased incomes. According to Mr. Hashim, radiologists' incomes are declining, and the trend has accelerated in recent years, particularly for younger physicians. "It's pervasive now," he says. "This year's fellowship class has had a very, very hard time."

Part of the decline in radiologist income can be traced to reimbursement cuts. However, hospital cost-cutting measures, particularly the elimination of radiology group subsidies and stipends, are a bigger driver. Additionally, says Mr. Hashim, "at the urging of organizations such as CMS and The Joint Commission, there have been significant utilization cuts, with more cuts on the horizon. You simply cannot buck the trend in a sustainable manner by employing doctors or cutting subsidies. You need to fundamentally transform the imaging program by appropriately deploying innovative cloud technologies and realigning the stakeholders: radiologists, providers, payors and clinicians."

4. Diminished role in healthcare. Even though care coordination is a large part of healthcare reform, radiologists have generally not been included in the industry-wide discussion.

"Radiologists are being disenfranchised," Mr. Hashim says. "They've been moved into reading rooms, or are sitting at home reading teleradiology, passively waiting for other physicians to order studies. They're not active at the front end of the patient care continuum."

Reversing the trends
Mr. Hashim believes that a change in the way radiology is practiced can make its future brighter.

"By changing the way radiologists practice, radiologists can stop the commoditization of their specialty and become an integral part of the post-reform healthcare equation. In essence, remain relevant and even lead change," he says.

For example, Imaging Advantage provides its radiologist partners with tools and technology to better align with hospitals and payors by delivering hard economic improvements and clinical changes. One such tool is called Radiology Advisor, an application not yet on the market that is designed to eliminate duplicate and unnecessary exams.

"Clearly, every market is unique. Every hospital is unique, with its own culture. But all are facing more or less the same economic challenges. We not only understand the situation implicitly, we have the means to do something about it," Mr. Hashim says.

For more information on Imaging Advantage's approach to radiology, click here.

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