The World of Radiology and Imaging Informatics Keeps Turning—Faster and Faster

Sept. 25, 2020
Policy, payment, market, operational, and technological changes are buffeting radiologists as never before; we’ll be discussing the winds of change in our Healthcare Innovation Imaging Virtual Day on Sept. 30

Editor’s Note: Healthcare Innovation is presenting our Imaging Virtual Day next Wednesday, September 30. Next Wednesday, we’ll host national leaders among radiologists, as well as business leaders in the imaging informatics space, for a discussion on how to strategize forward around imaging informatics in this constantly shifting landscape.

There really has never been a more unsettled and unpredictable time for radiologists and radiology than now, in U.S. healthcare. Even before the COVID-19 pandemic hit our healthcare systems, radiologists were already almost uniquely in the sights of federal healthcare policymakers, who have seen diagnostic imaging procedures as exceptionally expensive, and radiologists as exceptionally highly paid for what they do, even compared to other specialists. The Centers for Medicare & Medicaid Services (CMS) has been using a variety of levers, including Medicare fee schedules, to try to control diagnostic imaging expenditures in our healthcare system.

Nor is financial distress an abstract concern among radiologists right now. As we reported last month, a team of medical researchers produced an article this summer in the Journal of the American College of Radiology (JACR) online, whose conclusions, based on a survey of American College of Radiology (ACR) member organizations, found that radiology practices nationwide have been negatively impacted by the COVID-19 pandemic, with nearly 70 percent of all radiology practices having applied so far for financial relief. What’s more, the researchers found, in “COVID-19 Initial Impact on Radiology Practices: Survey from ACR/RBMA,” written by a team of healthcare researchers led by Ajay Malhotra, M.D., that, “During April 2020, nearly all radiology practices reported substantial (56.4-63.7 percent) declines in imaging volumes with outpatient imaging volumes most severely affected. Mean gross charges declined 50.1-54.8 percent and collections declined 46.4-53.9 percent. Percentage of reductions did not correlate with practice size. Majority of respondents believed that volumes would recover but not entirely (62-88 percent) and anticipated a short-term recovery, with a surge likely in the short-term due to postponement of elective imaging (52-64 percent). 15.6 percent reported that radiologists in their practices tested positive for COVID. Over half (52.3 percent) reported availability of personal protective equipment had become an issue or was inadequate. A majority (62.3 percent) reported that their practices had existing remote reading or teleradiology capabilities in place prior to the pandemic, and 22.3 percent developed such capabilities in response to the pandemic.” They conclude that “Radiology practices across different settings experienced substantial declines in imaging volumes and collections during the initial wave of the COVID-19 pandemic in April 2020. Most are actively engaged in both short- and long-term operational adjustments.”

A fluid radiological practice dynamic

What’s more, radiologists have felt a variety of levels of anxiety over the emergence of other factors as well. One has been the emergence of artificial intelligence (AI) and machine learning tools, which in theory will help radiologists improve their diagnostics and their workflow processes (including, for example, alerting them to reorder their execution of studies based on urgency of findings); the other has been the acceleration in radiology business conditions, particularly the ongoing encroachment of teleradiology and its rearranging of who works where and under what circumstances; and the ongoing consolidation of radiology practices from the historic “onesie-twosie” radiology practices, to larger and larger radiology practices, incorporation into larger and larger multispecialty medical group practices, and employment by hospitals and integrated health systems.

In that context, we reported earlier this month that, “In a sign of the accelerating consolidation of radiology practices nationwide, on September 10, the El Segundo, California-based Radiology Partners, the leading radiology practice in the U.S., today announced, via a press release, a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc., in a transaction with an enterprise value of approximately $885 million.” The acquisition did not happen in a vacuum: MEDNAX Radiology Solutions, which had grown very rapidly through acquisition, had faced considerable stress this year after the COVID-19 pandemic struck. We noted that, “Indeed, MEDNAX executives had had to announce difficult second-quarter financial results. On July 30, the company issued a press release with those results, stating that ‘MEDNAX, Inc. (NYSE: MD), the national health solutions partner specializing in prenatal, neonatal, pediatric, and radiology services, today reported a net loss of $8.03 per share for the three months ended June 30, 2020, primarily reflecting a non-cash loss on sale related to the Company’s previously announced divestiture of American Anesthesiology. On a non-GAAP basis, MEDNAX reported Adjusted EPS from continuing operations of $0.32. For the 2020 second quarter, MEDNAX reported the following results from continuing operations: net revenue of $509 million; net income of $8 million; and adjusted EBITDA of $65 million.’”

Radiologists buffeted by the winds of change

With all these different elements in the mix, it’s not surprising that radiologists themselves are feeling the winds of change. Many who are numerous years into practice are retiring or semi-retiring; those in the middle of their practice years are reconsidering their options along multiple dimensions.

Meanwhile, healthcare IT leaders in hospitals, medical groups, and health systems have never been in as meaningful position to make a real difference in the worklives of radiologists as now, as well as to really help their patient care organizations get to the next level when it comes to enterprise-wide imaging informatics, storage, image- and data-sharing, and collaboration in so many areas.

In that context, we at Healthcare Innovation are thrilled to be able to present our Healthcare Innovation Imaging Virtual Day next Wednesday, September 30. Next Wednesday, we’ll host national leaders among radiologists, as well as business leaders in the imaging informatics space. Some are radiology chairs at leading academic medical centers; others have been in the thick of things for decades, facilitating the creation of enterprise-wide imaging informatics, or advising the leaders of patient care organizations on how to strategize forward around imaging informatics, in this constantly shifting landscape.

We’ll look at such issues as the ongoing expansion of teleradiology firms and the impact of that phenomenon on radiological practice among radiologists still working in traditional medical groups and health systems; efforts to achieve true interoperability for image- and data-sharing, and the obstacles involved; the challenge of eliminating data silos and creating true enterprise-wide imaging informatics; intensifying demands from radiologists for continuously improved productivity and responsiveness; the impact of the consolidation of imaging service lines on health system IT departments; cloud-hosting and its implications for IT; the ongoing evolution of artificial intelligence and its applications in imaging diagnostics and in radiological study workflow; and other topics.

We’re so looking forward to hosting our three panels. And we hope that you’ll join us. There’s never been a more important time to have these broad discussions around the future of radiology practice, radiology in the context of health system strategy, and imaging informatics. Everything is changing all at once now, and healthcare leaders need to check in with one another to sort out both what’s going on, and where they want—and need—to go. Why not check in with us? The discussions are going to be lively and thought-provoking—and we’ve got the experts.

Meanwhile, the world keeps turning—and for radiologists and imaging informatics leaders, it’s turning faster and faster these days. There’s no reason to expect that things will slow down anytime soon; and the new world that’s emerging certainly looks to be interesting. The good news? Healthcare leaders of all kinds—clinicians and clinician leaders, administrative leaders, and healthcare IT leaders—will all be involved in helping to shape it.

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