How to take action against radiology threats: Part 2

In this two-part series, Dr. David C. Levin and Dr. Vijay Rao from Thomas Jefferson University outline actions that radiologists can take to address threats to the specialty. In part 2, Levin provides eight steps that radiologists can take to protect themselves.

Radiology is facing threats from all sides. Declining reimbursement, the move toward new payment models, bundling of CPT codes, commoditization, and increasing service demands from hospitals are just a few.

And with the perception on Capitol Hill that a large percentage of imaging is unnecessary, federal legislation continues to crack down on utilization -- with blunt, across-the-board cuts rather than more effective measures.

Radiologists can take action to address these threats, but it's important to keep the big picture in mind, according to a presentation given at RSNA 2012 by Dr. David C. Levin and Dr. Vijay Rao.

"Put the interest of patients first, behave like consulting physicians, and build bridges to referring physicians, patients, payors, and hospital administrators," Levin said.

In addition to Rao's 12 actions, Levin suggested eight more ways radiologists can protect the specialty.

1. Alleviate radiation dose concerns. "All the discussion we've seen in the literature in the past few years about radiation dose is hysteria, but we have to acknowledge the issue," Levin said. "We need to take whatever steps we can to reduce, record, and monitor dose, and to educate our referring physicians, patients, and the media."
2. Act like true consultants. "Radiology is now considered a commodity, and we have to offset that perception," Levin said. "Take back night and weekend call, screen for imaging test appropriateness, consult with referring physicians, and communicate test results directly to patients. Spend more time supervising advanced imaging exams, instead of letting technologists use a cookbook approach."
3. Create jobs for young radiologists. "In 2012, 42 of 187 radiology residency programs didn't fill," Levin said. "That means medical students are no longer trying to get into radiology -- they've learned there are no jobs. So make room for young radiologists in your practice, even if that means sacrificing some income. If we don't, the best and brightest young people, who have sustained our field for years, will go somewhere else."
4. Prepare for the era of lower reimbursement. "Reimbursements are going to continue to decrease, and what will drive this are things like accountable care organizations and bundled payments," Levin said. "Consider hospital employment -- it's a trend that's accelerating -- and think now about developing a strategy for future negotiations with hospitals. Also consider lowering your charges. I know it sounds crazy, but payors are looking aggressively for facilities with the low fees and steering their patients to them. You don't want to be considered a high-cost facility."
5. Emphasize radiologist expertise. "We are real doctors -- especially when we're involved in interventional procedures," Levin said. "Virtually every subspecialty of radiology is now involved in minimally invasive image-guided surgery, from breast imaging to chest and abdominal radiology to musculoskeletal and certainly interventional. Encourage the interventional radiologists in your group, even if their [relative value units (RVUs)] are lower than your film readers', and publicize your interventionalist role to hospitals. And negotiate for resources from your hospital, such as interventional procedure clinics, recovery areas, nursing staff, and care coordinators."
6. Know the self-referral evidence. "Familiarize yourself with the evidence that links self-referral to overutilization, and once you've done that, use it to lobby state officials and payors to restrict the practice," Levin said. "The feds don't seem to have the stomach to take this issue on, but there's more hope at the state level, and payors have begun taking steps to limit or eliminate self-referral as well."
7. Interact with news media. "Educate the media about actual radiation dose risks, what radiologists do, the specialty's quality initiatives, and the problem of self-referral," Levin said.
8. Show how radiologists add value to the healthcare enterprise. "Demonstrate to your hospital and your referring colleagues how the radiology department -- as opposed to nonradiologists or teleradiology firms -- adds value to patient care," Levin said. "What does your hospital get from your service that it doesn't from these other groups?"

Talking about threats to radiology can sound like a lot of doom and gloom, but there's good news, too, Levin concluded.

"Radiology will continue to be a highly paid, exciting specialty," he said. "The U.S. population is aging, and patients in the Medicare age group use imaging three to four times as much as other populations. The Affordable Care Act will increase the number of insured patients. And as consumerism becomes more and more of a force in healthcare, patients will want the latest and best medical technology available -- new technologies and applications for them will continue to be developed."