The Courage to Lead

Mission and confidence are important, but leaders in radiology today need courage

It was about this time last year that I started to think about the theme of this edition of Radiology Business Journal: Growth Strategies for Thin Times. My hope was that we would share insights, stories, and strategies from your colleagues that would be—if not uplifting—sources of inspiration to all. Back then I could not have predicted the tales that would be told in this issue, the new models that would unfold, and the great successes revealed that have been hard-won in a very punishing business environment.

What did not occur to me at the time was that this issue also would turn into a tribute to leadership and the courageous people who step up to assume that role. It is not an easy path, and there is no shortage of people who have tried and failed. What this issue makes eminently clear is that without great leadership, you can’t have a great practice, a great department, a great hospital, or a great organization.

Radiology in specific—and medicine in general—has become too complex based on the simple fact that demand is greater than ever, but the resources to pay for it are not there. A study(1) just released by The Urban Institute compares the effect of ACA coverage on the uninsured in 14 cities, in both states that have expanded Medicaid and those that have not expanded the program.

The authors project a 57 percent decrease in the number of uninsured by 2016 in cities located in states that have expanded Medicaid compared to 30 percent for those cities in states that have not expanded their programs.  Beyond the political point made by the leadership of states that declined the federal dollars lies the deadline in 2023 when the federal subsidies end and state’s will assume full responsibility. Whether the federal government, states, or providers (in the form of uncompensated care) pay the tab for the nation’s uninsured is less important than doing what we know needs to be done: bend the cost curve.

Not a Primrose Path

In its most recent report(2) to Congress, MedPAC continues to promote the idea of redistributing income to primary care physicians with a new central proposal to pay them a stipend for each patient in their panel.  The authors use radiologists as their example of a specialty that is, by comparison, overpaid.

While many radiologists would agree that primary care physicians deserve better compensation, the brief reference to radiologist income is not just cavalier, it is potentially irresponsible. Should CMS or Congress take this as an opening to make further cuts to outpatient imaging, we could end up losing an important and cost-efficient method of delivering the service. The cuts to the technical component must end.

Other concerns, having witnessed the dismantling of the Resource-based Relative Value Scale on our way to value-based care, is that what is emerging is a creaky, jury-rigged, overly complex physician compensation system when we should be seeking simplification in every aspect of medicine, from the administrative to the clinical. Will incentivizing already harried primary-care physicians to grow their patient panels promote quality and value in medicine? Given the crisis in the Veterans Health Administration, do PCPs need more patients, or do patients need more PCPs?

Given the extraordinary challenges facing radiology, the complexity of the healthcare environment, and the need for change, courage may be the most important ingredient for a leader today.

We lost a truly great leader earlier this month when Harvey L. Neiman, MD, FACR, passed away following a long illness. Knowing that Neiman was planning for his succession, I had hoped to interview him about the years that he led the college and his thoughts on what lies ahead. Sadly, I waited too long.  I remember the ACR prior to Neiman taking the reins as, I believe, the college’s first physician CEO. From an editor’s perspective, it was like a black box.  You would make a call, leave a message, and never hear back from anyone. Among his many other accomplishments, Neiman threw open the doors and windows to transform the college into an outward-facing, highly professional organization of consequence.

I don’t know the ACR’s new CEO, William T. Thorwarth, Jr, MD, FACR, personally, but I can presume that anyone who steps up to lead the specialty through this arduous transformation that must and will occur in the next decade necessarily has a great deal of courage, something he most certainly will need. May the road rise up to meet you!

References

1. Buettgens M, Dev J. The ACA and America’s cities: fewer uninsured and more federal dollars. Urban Institute. June 2014. Washington, DC.
2. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy. Published June 13, 2014. Accessed June 20, 2014.