CHICAGO – There’s a definite chill at this year’s Radiological Society of North America (RSNA) Scientific Assembly and Annual Meeting, and it’s not just the unseasonably cold temperatures made more miserable by the gray skies and wind whipping off Lake Michigan. Vendors have again crammed McCormick Place’s exhibit halls to the gills with their wondrous machines. Despite that and radiology’s long and prosperous history, speakers and attendees are murmuring about dark omens:
Accountable Care Organizations (ACOs), value-based purchasing models, and quality-based payer incentives reward physicians who err on the side of caution instead of ordering scan after scan on MRI machines. One speaker went as far as to encourage attendees watching his presentation to plan for radiology departments to become cost centers at hospitals, instead of the revenue centers most are in the present fee-for-service environment. That will likely change in the rapidly emerging fee-for-wellness model.
- Patients’ radiology images are increasingly being read outside the country, outsourced to countries where labor is cheaper.
- Radiology IT support is getting hit even harder: Radiology groups are increasingly considering outsourcing IT to the cloud as a cost-cutting measure. It can be done because today’s picture archiving and communications systems (PACS) and radiology information systems (RIS) are largely mature, stable products (as opposed to a decade ago, when they required care and feeding from onsite admins).
A public-relations guy for a very large hardware and software vendor – just chatting, not speaking for publication – observed a paradox unfolding at RSNA 2012: Radiologists have been known as technological innovators for a century, willing to try out any gear and employ it in their workflows if it helped improve patient care. But technology is currently looking like it might be the specialty’s undoing as the Internet and cloud make radiology departments portable and moveable to where the labor’s cheaper.
IT has taken a back seat to the other more clinical-focused tracks at RSNA in the past few years. This year, it’s the subject of keynotes, the focus of videos played before educational sessions, and plastered all over the front page of the show dailies. Clearly, these specialists see IT as a potential solution to buttress their practices against further erosion:
In his keynote, radiology meaningful use guru and vice-chair of Massachusetts General Hospital’s radiology department Keith Dreyer, D.O. implored radiologists to embrace EHR incentives – even though it requires the huge cultural shift of interacting directly with patients instead of through referring physicians. Meaningful use, he concluded, will improve performance and quality of care, patient safety and access to care—though it will require some investment in connectivity with physician EHR systems and may decrease productivity.
- In another keynote, one of radiology’s biggest thinkers, University of Chicago School of Medicine vice-chair of radiology informatics Paul Chang, M.D., called RIS, PACS and speech-recognition “relatively immature” technologies that support “commodity-level” radiology in the dying fee-for-service reimbursement model. He called for IT innovators to help break radiology out of its data silos and align with the rest of the hospital enterprise network – integrating RIS and PACS with EHR systems so that radiologists don’t have to waste time digging for information on every read. He also sees technology as a means to foster deeper, more active virtual collaborations with OR and ICU physicians.
- Working smarter and getting the most out of a continually shrinking slice of the health care revenue pie can be achieved with the help of analytics and business intelligence, said University of Utah Health Care informaticist Matthew Morgan, M.D., in a presentation. Such systems can help radiology practices uncover inefficiencies they can’t see with today’s simple spreadsheet reports.
RSNA itself has taken up the cause, marketing the theme “Patients First” everywhere at the show. Association president George Bisset III, M.D. kicked off the annual meeting with the urgent message that the Affordable Care Act and other economic forces are challenging radiologists to interact with patients more – which hasn’t been the norm for the current generation of RSNA members.
“I believe more firmly than ever that our future depends on our capacity to develop a new kind of shared ownership – along with our primary care and specialty colleagues – of our patients’ needs and expectations,” Bisset said.
It will be interesting to see if RSNA’s rank and file gets the message. Many of the folks I’ve spoken to in the halls and on the exhibition show floor fear meaningful use’s directives to share results directly with patients for three philosophical and business reasons: One, those patients might call or email and want a clearer explanation of radiology reports and the technical terms they contain. A scan only gives a snapshot in time; the radiologist can’t see a patient’s longitudinal history like his primary care physician can. Two, fielding such calls will take time away from income-generating productivity. Three, it could potentially foul the radiologist’s relationship with referring physicians, the financial lifeblood of a radiology practice.
The economic and health policy writing’s on the wall, but such change isn’t simple. Meaningful use was designed, in theory, to break down data silos between hospital departments. Radiology will have to put it into practice, its leaders think, in order to survive.