In a fascinating blog/report in Diagnostic Imaging this past spring, Whitney L.J. Howell shared some thoughts on what is going on, business-wise, in the radiology practice area these days. Citing a Diagnostic Imaging survey conducted in 2012 that found 70 percent of practicing radiologists to be “very” or “a little” concerned about facing an acquisition or merger, she looked at some of the factors pushing consolidation among radiology groups.
Ms. Howell quoted Kirk Rebane of Haverford Healthcare Associates, who noted that reimbursement cuts are a major factor in the acceleration of radiology group consolidation. As Rebane told Howell, “Healthcare reform has turned the tide toward the hospital being the center of healthcare as opposed to outpatient setting where it has been for the past 15 years. Now, imaging centers that physicians invested in and got good returns from for a while suddenly don’t look as good of an investment.”
Of course, as others whom Howell interviewed noted, there is a good deal of complexity involved here, because one of the effects of reimbursement cuts to diagnostic imaging procedures has been the commoditization of radiological studies, as radiologists have worked ever-harder and ever-faster in order to crank out more volume and keep up their overall compensation. And that in turn has made it more tempting for radiologists either to accept hospital employment, or to band together in ever-larger radiology groups for survival and especially in the attempt to maintain a strong position vis-à-vis the payers of healthcare.
Not surprisingly, there are definite strategic IT-related implications in all of this. One of the things that radiologists and radiology leaders have been telling me—particularly in my conversations with them at RSNA 2013, the annual conference of the Radiological Society of North America, held the week after Thanksgiving at Chicago’s McCormick Place Convention center—is that total efficiency and effectiveness have become absolute imperatives now in radiological practice, on multiple levels. First, radiologists are moving to implement critical-results solutions to optimize their efficiency in learning about and sharing with referring physicians any critical results from diagnostic imaging procedures. Second, they are implementing solutions that are leveraging automation to support radiological peer review, the gradual universalization of which is coming out of both policy and payment imperatives. Third, they are joining health information exchanges and are engaging in multiple channels through which they can readily share images with referring physicians and with fellow radiologists. Related to that, fourth, they are expanding the concept of teleradiology in all sorts of directions, as at Innovative Radiology in Houston. And fifth, they are participating in the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act.
What radiologists will further find is that, in advanced organizations like the University of Pittsburgh Medical Center (UPMC) health system, their performance will increasingly be monitored and analyzed using sophisticated analytics programs, as Rasu Shrestha, M.D., told me during RSNA. And all of this inevitable, of course, as the U.S. healthcare system moves steadily forward towards becoming more transparent, accountable, and outcomes-driven, under pressure from the public and private purchasers and payers of healthcare.
So what does all this mean for CIOs, CMIOs, imaging informatics directors, and other healthcare IT leaders? A lot, really. They should realize that, increasingly, practicing radiologists will turn to them for support and facilitation in making them, the radiologists more and more productive over time, in order to preserve, as much as possible, the compensation they’ve come to expect. Of course, some radiologists are already aware that the very high levels of compensation they’ve been receiving cannot ultimately remain where they’ve been. But they’ll certainly try to keep those levels as high as possible!
And then, for the younger radiologists, quality of life will definitely play a role in all this, as they increasingly make choices that their older colleagues have not made, trading that last margin of compensation for better working hours and more time with their families and at leisure.
So the intelligent leveraging of healthcare information technology will be absolutely vital to optimizing workflow and efficiency for radiologists going forward, whether they end up as hospital or health system employees or not. The reality is that the “new healthcare”—the emergence of a more transparent, accountable, quality outcomes-driven, U.S. healthcare system—has finally and truly come to radiologists, where they live. And radiology will never been the same again. And healthcare IT leaders can be heroes in this area, as in so many others, if they can improve the worklives of radiologists going forward. Will that be a challenge? Yes, of course it will. But the time is ripe.
