As accountable-care organizations (ACOs) take root around the country, radiology, as predicted by many, is proving to be a troublesome link in the care chain. Jordan Halter, vice president of solutions for Virtual Radiologic (vRad), says, “Radiology risks being seen as a cost center, to be managed, in the ACO model. Radiology must fundamentally and permanently alter itself to survive in the new fee-for-value health-care world. It’s no longer good enough to be available and affable; groups need to be accountable, affordable, and aligned with their hospitals, as Alan Matsumoto, MD, and the ACR® Council Steering Committee pointed out earlier this year. Radiology needs to be seen as a strategic partner with a seat at the leadership table, not as a cost center.”

On June 6, 2013, at the annual meeting of the Society for Imaging Informatics in Medicine (in Dallas, Texas), Eliot Siegel, MD, chief of radiology and nuclear imaging at VA Maryland Health Care System (Baltimore), copresented “Personalized Medicine.” He envisions a promising future for radiology—if the profession can surmount the obstacles that it faces, when it comes to big data. “Medicine in general is behind the curve on big data,” Siegel says, “and we have the chance to get radiology ready for the coming era of big data and personalized medicine, if we can address five key challenges.”

For the vendor-neutral archive (VNA), James M. Conyers says, making the A stand for archive no longer adequately describes the technology’s true capabilities. Conyers, national director of Enterprise Architecture Solutions for FUJIFILM Medical Systems, explains, “It’s more of an architecture than an archive. An archive is just one component of what the VNA actually does.”

The Inland Northwest, which we call home, is fortunate to have a legacy of health-information sharing among many organizations. These include the 97-radiologist private practice Integra Imaging (Spokane, Washington), formed through the merger of Inland Imaging and Seattle Radiology. Integra Imaging’s PACS archives host images for more than 100 sites.

With more than 800 active health IT applications to maintain, Bill Russell has no time for distractions. The senior vice president and CIO of St Joseph Health—a nonprofit integrated health-care network that includes 14 hospitals in California and Texas—has a lot on his plate. There’s even more since the system’s February 2013 affiliation with the network of Hoag Memorial Hospital Presbyterian to form the regional Covenant Health Network (Irvine, California), covering an area stretching from California’s Orange County to the High Desert.

As accountability in health care becomes an increasingly critical priority, many anticipate a future in which radiologists are employed by hospitals attempting to share risk and align incentives. Accountability can be achieved without employment, however, according to Carl Black, MD, of Utah Radiology Associates (URA), Orem/Provo, a 24-physician practice covering five hospital systems, including the oft-lauded Intermountain Healthcare (Orem). The practice’s relationship with Intermountain Healthcare was the subject of a presentation made by Black on July 28, 2013, in Minneapolis, Minnesota, at the annual meeting of the AHRA

Clinical analytics for radiology practices, in its current form, is defined by nothing so much as its limitations, according to Benjamin Strong, MD, CMO of Virtual Radiologic (vRad). “Practices don’t have the kinds of actionable insights they should, in terms of study characteristics, study mix, referring patterns, workflow, RVUs, and so on,” Strong says. “It’s something with which practices are struggling, if they’re even aware that they don’t have the analytics they need. We were managing blind during the good old days, and that continued for so long that many people don’t even miss analytics.”

On July 16, CMS announced the results1 of its accountable-care organization (ACO) program, the Pioneer ACO Model. The program was designed to test the impact of higher levels of shared savings and risk on ACO success, and it attracted 32 participants from around the country. After the first year of participation, seven Pioneer ACOs that did not produce shared savings announced their intention to transition to the lower-risk (and lower-reward) Medicare Shared Savings Program, while two dropped out of the ACO model entirely.