What Radiology Can Do to Improve Its Health

Everywhere one looks, these days, there is uncertainty about the future of radiology. Radiology technical and professional reimbursement is down, with further Medicare and private-payor cuts almost always on the horizon. Profit margins in imaging centers are down as a result of the Deficit Reduction Act of 2005, and professional revenue is down due to negative budget-neutrality adjustors to work RVUs. In addition, radiologists are reading more cases in an attempt to keep up with ever-increasing demand and to cope with declining compensation. Self-referral continues to plague radiology, as do various fee-splitting and leasing arrangements at imaging facilities. Malpractice-insurance premiums continue to be costly and lawsuits pose an ever-present threat to our practices.   Radiology service expectations also are rising, with a greater emphasis on increased radiology attending availability for urgent radiologic procedures performed after hours. As if these factors weren’t enough, radiologic technology keeps increasing, and the need to understand newer technologies is ever present. Considering these factors in the context of the overall macroeconomic picture of increasing food, transportation, and energy prices; declines in real-estate value; recent increases in unemployment; and a weak US dollar is enough to instill apprehension in even the most optimistic radiologist. Certainly, it is natural to wonder whether the issues affecting our profession can be addressed, or more important, remedied. Five Things You Can Do While we cannot fix the external environment, we all know that the world is not coming to an end and the sky is not falling, even though, at times, it seems that the end of the world may be approaching. More specifically, there are several things that each of us can do to improve financial and emotional health. First, it is important to maintain perspective. Even though radiologists may be working harder and facing negative financial pressures, we are considerably better compensated than the general population (the median US household income was approximately $48,000 in 2006).1 Radiologists also are better compensated than many primary care physicians, a fact that causes considerable ire among our primary care colleagues. Second, we need to start thinking about changing the way we view the increasing expectations placed on us. For example, as radiologists, we need to begin seeing the increasing demand for service as something that helps our profession, rather than burdens it. Our profession has an inherent risk of commoditization, which can be defined as the state in which consumers differentiate among products solely on price. By taking ourselves out of the darkroom and increasing our interaction with clinicians (and, potentially, patients), we increase our value and help ward off some of the risk of being replaced by another radiology group or an external radiology study-interpretation service. Third, we need to work with our payors and established radiology organizations such as the ACR to establish more stringent utilization criteria for radiologic studies. One of the reasons that reimbursement is declining per case is the rapid and continual growth of high-priced radiologic services such as CT and MRI. By working to minimize medically unnecessary radiologic examinations, we increase our credibility in the minds of the public and payors and, in the process, strengthen our profession. Fourth, we need to strengthen quality standards. The perception of quality differs between patients and physicians. As a general trend, patients see quality through the eyes of a layperson, often judging quality as the health care experience. This means that patients may judge us on wait times, facility cleanliness, and accessibility, rather than the technical sophistication of our equipment. Physicians, however, view quality in terms of scientific knowledge and training, which in radiology means appropriate examination technique and accurate study interpretation. Quality, from both the patient and the physician perspectives, is paramount. Improving quality as the patient sees it can translate into patient loyalty, which helps to ensure a steady stream of volume . Improving quality from a physician perspective can demonstrate to payors why, in many cases, radiologists provide more thorough examination results than other physicians interpreting diagnostic imaging. In other words, increased quality can strengthen our financial status and help combat self-referral. Fifth, we need to start paying attention to the economic environment in which we practice. There is a natural tendency for radiology practices to focus exclusively on interpreting more cases or producing more work RVUs. Certainly, clinical productivity is important, but without radiologist involvement in national radiology organizations and radiology economics, our destiny becomes increasingly out of our control. Physician apathy is a long-standing problem, only increased by the ever-expanding demands on our time. When viewed in a broader perspective, however, focusing solely on interpreting more studies in a shorter period of time does not address the larger economic forces affecting radiology, such as declining reimbursement, inappropriate utilization, and the potential commoditization of our profession.