Seltzer in JAMA: Should radiologists advocate broader or more limited use of medical imaging?

In an opinion piece published in the Journal of the American Medical Association, longtime radiology department chair at Brigham & Women’s Hospital, Boston, and CDS pioneer Stephen E. Seltzer, MD, poses the following provocative question: Should radiologists advocate broader use of medical imaging or become gatekeepers who take responsibility to control access and costs?

Seltzer and Lee go on to write that the dilemma creates a false choice for the profession, in that the former role denies the patient care responsibility of the radiologist as physician, while the latter creates an adversarial relationship between radiologist and referring physician. The answer, they write, is for radiology to become more integrated into the patient care process by becoming members of care delivery teams.

The authors acknowledge the role of diagnostic imaging as a healthcare cost driver, as well as the consequences: pre-authorization, reduced fee schedules and sluggish coverage decisions on new applications of imaging technology.

They also note that new value-based payment models such as bundling would convert diagnostic imaging into a cost center from the profit center it has been under fee for service. This shift creates potential moral and financial dilemmas for radiologists and their institutions.

The proper course is to practice patient-centered care, and do the right thing for each patient, Seltzer and Lee write, adding that several roles are emerging for radiology in the new healthcare paradigm, in which they partner with IDNs to manage utilization and cost, to:

1. oversee the content and implementation of clinical decision support software that can be delivered at the point of care,
2. perform consultative services related to the appropriate use of imaging and the implication of results,
3. profile the use of imaging tests to provide feedback and education to clinicians, and
4. leverage lower-cost community based imaging sites and teleradiology for subspecialist care.

Fundamental change in care delivery will be required of hospital-based specialties such as radiology, the authors assert in their paper. “Radiology, typically a critical contributor to the quality of patient care, as well as the economic health of integrated systems, may be a bellwether case study about how these forces can provide leverage to change fundamentally the care delivery and funds flow model of a very well-established medical specialty,” they conclude.