Closing out the books on 2014

As the year winds down and thoughts turn to 2015, it’s always a good idea to look back and review where we have been and what has transpired since we passed this way before. For radiology, it was a year of great importance.

At this time last year, many in the profession were looking for a path forward into an uncertain future. This year, radiology has so many important new initiatives and responsibilities for which to prepare that the challenge will be finding a still moment this holiday season to reflect. Let’s give it a whirl.

The good news—a clear purpose. In passing the Patient Access to Medicare Act, Congress dissuaded radiology from thinking it had no place in the new order of healthcare by providing the specialty with a purpose: Implement radiology decision support. By 2017, physicians ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) must consult government-approved, evidence-based appropriate-use criteria through a CDS system. Physicians furnishing advanced imaging services in their offices, hospital outpatient and emergency department settings will be paid only if claims for reimbursement confirm that the appropriate-use criteria was consulted.

The bad news—it won’t be a cakewalk. Implementing radiology decision support will not be easy. While providers won’t be hamstrung by some of the constraints faced by the conveners in the recently concluded Medicare Imaging Demonstration, they will encounter many of the same challenges. One of them is a ticking clock. Conveners had just six months to implement decision support and you have two years, but considering the obstacles and the unknowns, it’s not a lot of time.  Start planning right after the holidays.

The opportunity—lung cancer screening. This was a real roller-coaster ride, beginning on a high note with the USPSTF grade B recommendation for lung cancer screening, digressing with the MEDCAC vote of low confidence and, ultimately, achieving a positive Medicare coverage decision. This decision represents a tremendous opportunity for radiology to help reduce mortality from the leading cause of death by cancer in men and women. Radiology has been here before with mammography, and the advice of NLST investigators is to build on that infrastructure. There also is the benefit of learning from mistakes made. In your enthusiasm to save lives, don’t over-promise.

Everything else—the alphabet soup. As if this weren't enough to contend with, radiology—and the rest of healthcare—faces the impending transition to ICD-10 and all that entails. Keep in mind that this gets us a step behind much of the rest of the civilized world, which is working with ICD-11. Then, of course, there is MU stages 1 and 2, PQRS, Hospital and Physician Compare and the HCAHPS. Find the efficiencies in your compliance.

Births, deaths, and anniversaries. This year marked the birth of a new web site and home base for Radiology Business Journal, RadiologyBusiness.com. It’s been an eventful first year at our new home with TriMed Media, and we’ve demonstrated that there is more than enough going on in the business of radiology to feed a web site with daily news. We have great plans for 2015, so stay tuned. The year of 2014 ended on a high note, with RSNA celebrating its centennial, and RadLex marking its first decade. Sadly, this year also marked the passing of one of radiology’s great leaders, Harvey L. Nieman, MD, the gifted and visionary CEO of the ACR.

Take time this holiday season to dwell in what my priest calls the thin moments, which I interpret to mean the space between everything you have to do and all of the baggage you carry with you. Partake in the season of waiting, wonder and miracles: A virgin gives birth, a menorah burns for eight days on oil enough for one night and a messiah is born.  However it is that you celebrate, I hope the holidays bring near all that you hold dear.

See you in 2015!

Cheryl Proval