JACR: Radiology faces a slew of economic, political challenges in 2012

The transition to a new year lends itself to reflection on the past and preparation for the future, and an article in the January issue of the Journal of the American College of Radiology takes the opportunity to do both by looking back on ACR’s 2011 Annual Meeting and Chapter Leadership Conference (AMCLC) where a major topic of conversation was the challenges facing radiology heading into an uncertain future.

Authors Jay A. Harolds, MD, of Michigan State University in Grand Rapids; Alan D. Kaye, MD, of Bridgeport Hospital in Bridgeport, Conn.; and Mark J. Adams, MD, MBA, of the University of Rochester School of Medicine and Dentistry in N.Y., wrote that there are a number of serious market and governmental forces affecting radiology, and radiologists must improve the quality and cost-effectiveness of their practices to ensure survival.

“Undoubtedly, we are headed for a new paradigm in which there are new core principles,” wrote the authors. “Increased attention will need to be paid to patient outcomes and cost-effectiveness, individual and group norms, performance measures and documentation, teamwork and sharing of data.”

Kaye presented a series of challenges facing radiology at two open microphone sessions at the 2011 AMCLC on May 16 and 17, and got reactions from attending councilors using an audience response system. Many radiologists expressed unease at the number of changes in the healthcare system and the implications those changes will have on their professional lives, job security, personal satisfaction and ability to provide quality care or engage in research.

The Deficit Reduction Act, the sustainable growth rate and multiple-procedure discounts for contiguous body parts are just some of the challenges to reimbursements, according to the authors.

“Declining reimbursement and delayed retirements due to lower-than-expected retirement plan valuations are believed to be having an adverse effect on the job market for young radiologists,” wrote the authors. “There are concerns about a repeat of the diminished attractiveness of radiology to medical students that occurred in the 1990s, when concern about managed care led to a short-lived decline in applications to radiology resident programs.”

Private practice structures are also undergoing change, according to Harolds et al, as more radiologists are being employed by hospitals, more capitated payment plans are being used and there’s a growing push to have healthcare providers participate in accountable care organizations.

Then there’s the problem of overutilization of unnecessary procedures, which by some estimates accounts for 30 percent of all care provided in the U.S. While the Patient Protection and Affordable Care Act (PPACA) attempts to reduce costs in some areas, the authors noted that confidence among radiologists regarding the PPACA is diminished because “they do not see a strategy to deal with the major sources of overutilization in imaging: self-referral and defensive medicine.”

In addressing how radiologists should approach these challenges, the authors pointed to John P. Kotter, PhD, professor emeritus at the Harvard Business School and chief innovation officer at Kotter International, who said radiologists should follow a multi-step change management plan that includes:

• Establishing the immediacy and importance of change;
• Assembling a team of people with sufficient power and credibility to make the changes occur;
• Communicating the new vision;
• Elimination of obstacles making it difficult for people to perform; and
•  Transforming the culture of the organization to keep the changes in place.

Other specific suggestions for radiologists provided by the authors included maintaining good relationships with hospitals and colleagues by teaching referring physicians or residents, as well as seeking leadership positions in their hospitals. Radiology groups also need to be proactive and listen to feedback from other practices.

“In the longer term, radiologists must be flexible in the uncertain times ahead for healthcare, medicine, research, and our country and its economy,” wrote the authors. “Some of the threats will become reality, and some will not. Some will present opportunities for well-led, forward-thinking practices and departments.”