AJR: Radiology to see fewer independent practices, more commoditization

Over the next decade, new radiologists will be starting on career paths that look quite different from the paths of today’s radiologists, and they will potentially face a future that trends toward increased commoditization of radiology services, according to a web exclusive article published in the American Journal of Roentgenology.

Author Eugene Lin, MD, of the department of radiology at Virginia Mason Medical Center in Seattle, began the article with a general contrast between the career paths of radiologists who entered practice in 2005 and those who will be starting out in 2020.

In 2005, according to Lin, new radiologists were likely to join a practice with a secure hospital contract. The group he or she joined may also practice in outpatient centers that could be joint ventures with a hospital, owned by the practice or owned by a nonhospital business entity. Radiologists may eventually become partners in the practice, sharing the profits, which are determined largely by volume.

But the practice realm has begun to change.

“Because of recent changes in technical fee reimbursement, nonhospital outpatient imaging is less profitable for both radiologist owners and self-referring clinicians, and outpatient imaging will likely become increasingly hospital-based,” wrote Lin.

Lin predicted that new radiologists in 2020 will likely be employed by hospitals, multispecialty groups or nonhospital corporations, with those entering private practice joining groups that would be very large by today’s standards. Independent outpatient practice will be uncommon. There will also be less security in practices because local groups will be competing with national practices for hospital contracts, according to the article.

The American Board of Radiology exam will no longer be the definitive designation of quality and radiologists will be asked to provide additional evidence that the work they do is valuable, with studies that don’t meet certain metrics for performance and interpretation being reimbursed less or not at all, according to Lin.

The author was skeptical of sentiments that imaging volume will continue to increase regardless of cost-saving measures because of an aging population and the development of new imaging techniques.

"It is very difficult to imagine any scenario in which payors will allow overall imaging costs to rise substantially,” wrote Lin. “There is substantial room for decreasing imaging volume if inappropriate, self-referred and defensive imaging can be limited.”

He outlined three general trends that radiologists can expect going forward:

• A substantial decrease in financial incentives encouraging increased imaging volumes, and a shift toward incentivizing quality and value;

• Radiologists will have to prove their value to hospitals and payors relative to other radiologists and practices beyond their board certification; and
• Increased commoditization of radiology services.

The growth of teleradiology is an example of commoditization, and Lin said radiologists must adapt to its existence in the marketplace. As more radiologists are attracted to teleradiology, for any number of reasons including geographic flexibility, lifestyle and income, there is an increased possibility of commoditization.

Likely scenarios for effectively controlling imaging costs will include explicit controls, such as decision support systems and prior authorization; indirect controls, such as bundled payments and shared savings; and decreased technical and professional reimbursement. The accountable care organization model may become a more prominent feature in the future of healthcare delivery, according to Lin.

Of course, these are merely predictions, and Lin reminded readers of challenges of predicting trends with a Yogi Berra quote: “It is tough to make predictions, especially about the future.”