To survive, radiology should become a horizontal

The future of radiology is bright, but its not so clear for radiologists....Lawrence Muroff, RSNA 2012

I attended the recent RSNA in Chicago this year.  Each year 60,000 people come to talk and sell all things imaging.  However, after years of short sighted, self destructive life style based decisions, radiologists have now successfully commoditized their specialty.  Although imaging will remain central to care, reimbursement for these services will likely change to align with the ACO/CIO agenda.  It remains to be seen if the specialty can reinvent themselves moving forward. 

Image isn't everything.

Radiologists are obsessed with the image.  This is understandable.  No other the speciality takes ownership of the quality and safety related to image production.    However, this focus on constant image improvement has to some degree been at the expense of image value for the patient. In the new world of value based care, every provider, every speciality will be measured against the patient's ultimate outcome.  Traditionally, radiology's relationship with the patient ends with the dictation.  There is no follow up.  Did the study decrease morbidity or cost of care?  Were care decisions influenced by imaging findings.  Were there differences between general and specialist interpretations influencing outcome or utilization?  This type of information, eminently obtainable via patient registries or directed personal health records, would add relevance to discussions with the payers moving forward.

Radiology as a “horizontal”

Radiologists and the imaging vendors can continue to ignore the the changes going on around them, or perhaps it is time to think about “creative destruction” of imaging.  These is a phrase coined by Eric Topol reflecting the rest of healthcare. 

Today, radiologists are paid for the transaction, the dictation.  Tomorrow we are paid for patient value.  How can we cross the chasm to this new world?

There is some good news.  There are some unique aspects of imaging services.  Unlike almost any other field in healthcare, radiology is a horizontal.  As opposed to neurology, obstetrics, surgery, relatively siloed verticals of care, imaging is required for all areas of medicine.  Radiologists have a broad understand of care across the continuum and could help navigate the patients course, suggesting appropriate next steps to arrive at cost effective diagnosis.  

(Radiology circa 1965...the reading room was the center of the hospital)

I am not suggesting the imaging subspecialists generalize themselves, but rather imaging services as a department begin to think of themselves as part of the care team, requiring and synthesizing clinical information to offer appropriate next steps.  Vagaries such as “stroke” or pain should not be accepted as clinical history.  Comparison studies should be found.  After an imaging study, there should be ownership of the outcome so that radiologists can effectively participate in utilization management.

These changes will not happen over night.  Currently, the IT tools supporting this type of practice are not offered- but markets respond.  If there is an ask, there will be product.  This is also anathema to the current practice patterns- aka, the referent is always right.  

Currently, it is almost like there is a sense of the “end of days,” make as much as you can now because the end is coming.  The end isn’t coming.  Imaging is here to stay.  Change is coming.  We can chose to plan for it and align with value, or deal with an abrupt, painful transition