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Crashing Waves Hit Radiologists in a Time of Accelerating Change

November 8, 2016
by Mark Hagland and Heather Landi
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A combination of policy, regulatory, payment, business, and technological trends is leading to dramatic change in the practice of radiology and in imaging informatics

The world is changing rapidly, and with it, the U.S. healthcare system—and with the healthcare system, so, too, the world of radiology and imaging informatics. Among the most bracing trends, emerging out of a very broad range of different sources, that are affecting the practice of radiology and the use of imaging informatics:

A massive and unprecedented shift from volume to value in the policy and reimbursement area is taking place now. This shift had already been underway for several years because of the implementation of the mandatory value-based purchasing program and the avoidable readmissions reduction program for physicians and hospitals, under provisions of the Affordable Care Act (ACA); but that shift has been accelerated by the passage of the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) by Congress in April 2015, with the MACRA final rule being published on Oct. 14, and set to be implemented beginning Jan. 1, 2017, and with all Medicare-participating physicians then being pushed either into advanced payment models (APMs) or into the MIPS (Merit-based Incentive Payment System) program. And those changes only compound the policy changes facing radiologists, as referring specialists will soon be required to make use of appropriateness criteria when ordering diagnostic studies.

> Partly driven by policy and payment shifts, a massive consolidation of the healthcare provider sector is underway, with physicians, including radiologists, in the smallest practices, joining either larger radiology groups or large multispecialty groups, or choosing direct employment by hospitals, and with imaging centers also consolidating.

> A combination of advances in information and communication technology is making it far easier for radiologists to work remotely, and spurring a shift of many radiologists into virtual groups or working as individuals for remote-reading services.

> Advances in information technology and in interoperability are changing imaging informatics, with PACS (picture archiving and communications systems) systems increasingly being folded into VNAs (vendor-neutral archives), which are incorporating not only radiological images, but also images from such medical specialties as cardiology, pathology, dermatology, and gastroenterology.

> Changes in technology and business are accelerating an already vigorous pace of consolidation among imaging informatics vendors, resulting in a far smaller number of increasingly larger solutions providers, and, with electronic health record (EHR) products increasing in sophistication, a plummeting level of interest in standalone RIS (radiology information system) solutions, except at the smallest, non-networked radiology practices.

> At the very leading edge of technology, the Armonk, N.Y.-based IBM announced in June the creation of the new Watson Health Medical Imaging collaborative, a global partnership that is bringing together 16 vendor, health system, and academic partners to improve cognitive imaging for radiologists and referring providers in many specialties. That collaborative’s leaders are looking to leverage big data to improve clinical decision support for radiologists and for referring physicians. Other initiatives are aiming at bringing machine learning-based tools into radiological practice in earnest. And the implications of all such initiatives are major, in terms of how radiologists will work in the future.

All of these changes in U.S. healthcare are fundamentally changing the landscape of radiology practice and of imaging informatics, at a time of both innovation and uncertainty for radiologists, always historically among the most technology-embracing of medical specialists.

What Do Industry Leaders Think Will Happen Next?

Rasu Shrestha, M.D., the chief innovation officer at the 20-plus-hospital UPMC health system in Pittsburgh, and a practicing radiologist, says that the release of the MACRA final rule will be excellent for radiology and for radiologists, particularly as it replaces some of the quality-focused measures under the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act with a new set of measures that he believes will more accurately measure radiologists’ and other physicians’ contributions to the quality of care delivery. “MACRA really is about moving to a continuum of scoring versus an all-or-nothing system, as Farzad [Farzad Mostashari, M.D., the former National Coordinator for Health IT] said [recently], and I think that’s spot-on. Meaningful use has been about looking at quantity—the numerator-denominator game we’ve been playing. Now we’re actually looking at quality, so there’s a movement and a validation, and a push, for us to actually get to value. I think this is actually awesome for radiology and radiologists,” Shrestha adds. “This basically substantiates a lot of the discussion that radiology has been leading in the last couple of years, moving from volume-based to value-based imaging.” In fact, he says, “I think radiology has also been the bellwether for healthcare on this.”


Rasu Shrestha, M.D.

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