The Flat World Imperative

In a world where a radiologist in Bombay can interpret an x-ray from Buffalo, the Mayo Clinic’s Stephen Swensen, MD, maintains that quality is the only way to distinguish a radiology service. In the February issue of Imaging Economics, Swensen makes the business case for quality and describes the Mayo Clinic approach. Why does a continuous quality improvement initiative make financial sense? First, radiology is vulnerable to commoditization not only because of low-cost providers abroad, but it is also threatened from within by teleradiology companies and cross-town competition.

“If you have two or three hospitals in a city, you should be able to show why your results are better or why someone should come there. Otherwise we become a commodity and people will just go to the lowest price.” —Stephen Swensen, MD

Swensen also cites physician professionalism and the impending Medicare pay-for-performance quality initiative, the bargaining chip played by CMS in exchange for keeping physician reimbursement stable until 2008. The American College of Radiology is developing quality measures around three patient safety issues:

• Communication of Diagnostic Imaging Findings
• Radiation Dose Management in CT Procedures
• Management of Intravascular Iodinated Contrast Media Administration.

When final, the measures will be posted on the ACR web site for comment. Meanwhile, it is likely that all radiology providers will be called on to make the choice between being a commodity provider and a quality provider.