Radiology needs to become more efficient to adapt to the shift in the U.S. to value-based care, according to a presentation January 24 by Dr. Giles Boland on the future of medical imaging at Arab Health 2022 in Dubai, United Arab Emirates.
Dr. Giles Boland. Image courtesy of Robert Stevens.With reimbursements currently declining and numbers of patients increasing, the bottom line is that it's becoming harder to make money, he noted.
"And the reality is, if you don't make money in an organization, you can't fund your mission," Boland said.
Boland is president of the Brigham and Women's Physicians Organization, a faculty practice plan of more than 1,800 physicians affiliated with Harvard University in Cambridge, MA. In his talk at Arab Health, he discussed challenges currently facing radiology and offered views on how Harvard's network of 12 affiliated hospitals is moving forward.
Consolidation is key
Hospitals are merging, partly as a response to decreasing reimbursements from the U.S. Centers for Medicare and Medicaid Services (CMS), which provides about half of the pay for health systems, Boland said. They are increasingly joining forces with community hospitals to form new networks so that they can coordinate care for larger patient populations and ultimately increase revenue.
The challenge is that healthcare facilities all have their own culture and legacy, as well as different protocols. In 2018, while chair of radiology at Brigham and Women's Hospital, Boland and colleagues brought their radiology departments together first by moving to a single PACS network.
They had seven PACS networks in use at Harvard affiliates, and nobody wanted to give theirs up, he said. Moreover, vendors were only interested in selling their systems in the other environments. In the end, they dropped them all and implemented a single PACS to the tune of $25 million.
Next, they focused on harmonizing protocols so that the same MRI protocol is used, regardless of whether the MRI scan was acquired at a community hospital, an outpatient center, or an academic medical center. Now patients can navigate the system and know that if they go to an outpatient center, they are going to get the same quality as they would at the academic medical centers, Boland said.
"And, by the way, at lower costs," he added.
Take note of 'disruptors'
Patients are frustrated, Boland said. Studies suggest 70% of patients say they do not have a seamless experience when they enter a healthcare system. And retail health organizations like CVS and Walgreens in the U.S. are exploiting this fact to chip away at the traditional healthcare market, Boland said.
For example, a majority of patients opted to go to retail pharmacies and other such facilities rather than traditional healthcare providers for vaccines during the pandemic partly because they are more convenient and provide a better experience. Boland added that he got his shots at a local pharmacy simply out of convenience.
It is going to be very difficult to compete with these groups, Boland said. They're too big, too fast, and too nimble.
"They're too clever, if you will," he said.
At best, Boland said healthcare leaders may want to explore how to coordinate care with these giants in retail health because they are not going to go away.
IT innovation
Capitalizing on IT innovation, specifically artificial intelligence (AI), will be important in the coming years as radiology becomes more complex, Boland said.
Physicians will need to set aside fear that AI will replace their jobs. Radiologists using AI algorithms are like pilots flying planes, he said.
Sure, you can take off from Dubai and go wherever you want without a pilot. But there are more pilots today employed than ever before, Boland said. Why? Because they need a pilot to make sure that the systems are controlled properly.
"We are not going to trust artificial intelligence tools to make their decisions on their own," he said.
Ultimately, AI programs will simply be providing clinical decision support. AI algorithms are in use for cervical smear screening, for instance, and appear promising in breast cancer screening. Data mining electronic health records to obtain information that can help save time on differential diagnoses is another promising approach.
"This is the way we need to go," he said.
Outpatient delivery models
Another major trend in healthcare is to move patients away from expensive hospital care into the outpatient environment, Boland said. At his organization, Boland said plans are in place to build more outpatient and ambulatory medical centers that include surgery and radiology.
"The key is, if you're going to do that, you need to make sure you're delivering the same quality of care at all of these sites as you do at the main hospital," he said.
Otherwise, you're confusing the patients, and they'll start to think they get better care in the hospital and won't go, Boland said.
Engage in diversity, equity, and inclusion efforts
Ensuring diversity and equity in care became a focus way too late, according to Boland. He said published studies out of Brigham and Women's have shown physicians treat white patients differently than Black patients. Moreover, outcomes are different for white and Black people.
Key questions for leaders in healthcare include whether they are employing a diverse set of employees.
"The people we hire in the U.S. should reflect the patients we care for," he said.
Boland related an anecdote regarding a C-suite executive in his organization who took down pictures of all the previous chairs in his hospital's main conference room. Why? They were all white men, he said.
"And they all came down because they did not anymore reflect who we are and who we care for," Boland said.
Ultimately, the most important step for leaders moving forward in today's current landscape is to embrace change, Boland said. Change management is difficult in any business. It requires working together with stakeholders and finding clinical leaders who can make the mental shifts required.
Boland said the worst thing for an administrator, or hospital president like himself, to say to a clinical team is, "I don't care what you think, just do it."
"That's not a way to run a practice," he said.
