Radiology’s Best Days

Turning the page on the old year and welcoming in the new is a vital, annual life passage whether one goes about it quietly or with a noisemaker and a party hat. People and businesses both benefit from a bit of reflection, recognition of a deal well executed and the resolve to attack something new—or anew—in the New Year. The same applies to medical specialties, so let’s give radiology its due.

First, heave a collective sigh of relief for the correction of perhaps the greatest insult to radiologists in the 21st century—the professional multiple procedure payment reduction (MPPR). It may not represent the greatest revenue cut to practices, but it was the most outrageous, coming as it did in 2012 on the heels of so many cuts to the technical component.

The passage of the Consolidated Appropriations Act on December 18, 2015, contains a long-overdue rollback of the 25% discount to just 5%—closer to actual savings as calculated by ACR—on the interpretation of multiple procedures performed on a single patient in a single episode of care on a single day. The fix doesn’t kick in until January 1, 2017, meaning that the specialty will experience a full five years of an arbitrary pay cut that completely ignored established reimbursement methodology. Would you make that retroactive, please?

I asked two practice CEOs for a ballpark estimate of what this could mean to revenue, but neither of them had the numbers yet. After the MPPR was implemented in 2012, other payors jumped aboard at various times, so sorting out the impact will be a challenge.

This likely had passed off most radar screens, so the rollback of the professional MPPR is a testament to the tenacity of your voice in Washington. Besides that, the MPPR was just plain wrong.

Local climate, big picture

In our most recent survey of the 100 largest private radiology practices in the U.S., increases in revenue between 2013 and 2014 (the most recent year-over-year comparison available) tracked fairly closely to increases in productivity.  Likewise, decreases (representing about 1 in 3 practices that reported financial data) also were associated with declines in productivity. Were radiologists taking longer vacations and spending more time on practice building or did the practices with declining revenue lose volume and clients?

While radiology continues to provide private practices and their employees with interesting and rewarding work, there is a growing sense among those who take their living from the specialty that the good days are behind us. Certainly, developing and managing a successful medical practice has become exceedingly complex.

All of medicine is smarting from a heightened level of cost management, but radiology may feel it most acutely having ridden a wave of astonishing technological innovation that began in the 1970s. Some bemoan the lack of technological innovation in radiology today, but we don’t need another 60 or 120 slices of CT information right now. At  some point, the advances in resolution would be beyond the ability of the human eye to process—unless someone develops a headset and software that could process the information for you.

The next big thing

Since the completion of the Human Genome Project in 2003, researchers in medicine have been busy seeking the genetic basis of disease. These activities have been particularly fruitful in cancer research, where scientists are moving beyond genetics to pinpoint biological cancer markers. What does the age of genomics mean for anatomic imaging? What are the implications of proteomics for functional imaging?

A company that makes gene-sequencing machines recently announced that it had launched a spin-off to develop a test to detect genetic evidence of cancer in the blood.1  The CEO hopes to have a “pan-cancer screening” to detect the presence of any cancer on the market by 2019, priced  below $1,000.

At that price, it’s unlikely to threaten your mammography business any time soon. To self pay, you’d have to be in the financial strata of Jeff Bezos or Bill Gates—both tech titans have helped finance the new company. That a pan-cancer test would rival the sensitivity and specificity of mammography, even with all of its warts, is unlikely. Still, radiology should be thinking about how genetic testing might alter cancer screening and workup—especially for breast or lung cancer as screening programs roll out.

In 2016, more near-term questions to ask may be these: Is the specialty maximizing the value of the information that it has? Is that information appropriately shared to the right people for the highest possible impact?  Can radiology do more to improve patient outcomes?

Looking ahead, it is a thrilling time to be in medicine. I think your best days are before you.  

Reference: Winslow R. Illumina project seeks gene-based cancer blood test. Wall Street Journal. January 11, 2016. Accessed January 12, 2016.