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LIVE FROM RSNA 2012: Are Radiologists Facing Existential Threats—Or Exciting Opportunities?

November 29, 2012
by Mark Hagland
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As RSNA 2012 wound toward its close in Chicago, industry leaders parsed some of the complex issues facing radiology and imaging informatics

As RSNA 2012, sponsored by the Radiological Society of North America, and being held Nov. 25-30 at Chicago’s McCormick Place Convention Center, wound toward its close, the atmosphere this year seemed to be one of nervous anticipation, with many attendees looking for signs and signals of all kinds. It’s not just that attendance is down this year (RSNA officials expected that the final attendance tally would end up somewhere around 53,000-54,000, compared with 58,000 in 2011,  representing a drop of something like 5 or 6 percent); there was the sense among many attendees that radiologists will only experience more and more pressures coming out of healthcare reform and market competition in an increasingly challenging practice environment.

What’s clear to everyone is that the gravy days of high reimbursement and low controls on radiologists’ practice patterns are over. As one of the more highly paid medical specialties, radiology has for several years been in the sights of Washington policymakers from both parties. Indeed, with both public and private payers pushing limits on reimbursement for diagnostic imaging services, the volume of imaging procedures has declined considerably in recent years. As an article in the September issue o f the Journal fo the American College of Radiology reported, Medicare Part B spending on non-invasive diagnostic imaging exploded from $5.9 billion in 2000 to $11.9 billion in 2006, but then fell to $9.4 billion in 2010.

What’s more, many radiologists are deeply fearful of what might happen in Washington, D.C. in the next several months, as federal legislators face a variety of budget issues, among them not only the so-called “fiscal cliff,” but also the prickly issue of needing to resolve the “SGR [sustainable growth rate] problem” under Medicare—the resolution of which could well hit specialists far harder than their primary care brethren.

More broadly, of course, the underlying reality facing policymakers is this: the current healthcare cost trajectory is unsustainable. Looking just at federal healthcare spending, Medicare expenditures are expected to double within the next decade, as the U.S. population ages, and chronic disease (some of it obesity-driven) affects more and more Americans.

In conversations with industry luminaries like Keith Dreyer, M.D., and Rasu Shrestha, M.D., it’s clear that the old patterns cannot hold; and, as James Whitfill, M.D. notes, radiology practices are actually failing now in market’s like his, in Phoenix.

But as Drs. Dreyer, Shrestha, and Whitfill all agree, radiologists will have to become more patient-centric, and will have to change the way they practice in order to benefit from the shift towards accountable care, bundled-payment contracting, and other new delivery and payment systems, not to mention the promising phenomenon of health information exchange.

Can technology play a role here? Absolutely. Indeed, a broad consensus is emerging over the idea that the shift to robust clinical decision support might at least to some extent offset the onerous effects of the radiology benefit management programs that are so bedeviling practicing radiologists these days. But where will these CDS tools sit? And how can images be incorporated into enterprise-wide image and data archives that improve workflow and clinical effectiveness not only for radiologists, but also for referring physicians?

As Dr. Shrestha notes, the vendors are still too locked into the old PACS idea. And though “VNA” (vendor-neutral archive) continued at this year’s RSNA to be as hot a buzz-term as it was last year, Joe Marion notes, “[I]t’s inevitable that because of the EMR integration, that imaging is going to have to expand beyond just radiology; it has to. And particularly so as it becomes more and more of a factor in meaningful use. So we’re moving towards an enterprise focus. “

But as all those I spoke with agreed, a very large challenge faces vendors in the imaging informatics arena, one that will inevitably cause some vendors to rise and others to collapse, depending on how they adapt to some of the fundamental changes taking place now across healthcare.