AJR: Radiologists dangerously uninvolved in healthcare policy

As the U.S. devotes increasing attention to improving the value of the nation’s healthcare, radiology has relegated itself to the backseat, failing to adequately train its specialists in the subspecialty of health services and thus leading to a clinical and policy space where radiologists are stuck on the outside, watching more versed specialties determine the future of U.S. healthcare, argued the authors of a review article published in the May issue of the American Journal of Roentgenology.

With the cost of care growing uncontrollably and patient outcomes beginning to slip, U.S. policymakers and clinicians have responded with dramatic reforms to improve the country’s healthcare value. Many of these reforms will depend on the effects and evidence obtained from piecemeal pilot models, such as accountable care organizations (ACOs), pay-for-performance and bundled payments.

The subspecialty of health services has come to be seen as the bedrock for the implementation of these new models, according to Christoph I. Lee, MD, from the Robert Wood Johnson Clinical Scholars Program at the University of California, Los Angeles (UCLA) David Geffen School of Medicine, and Howard P. Forman, MD, from the department of diagnostic radiology at Yale University School of Medicine in New Haven, Conn.

The authors cited the Academy for Health Services Research and Health Policy’s definition of health services research, defining it as “the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies and personal behaviors affect access to healthcare, the quality and cost of healthcare and, ultimately, our health and well-being.”

The U.S. government has set the stage for evidence-based health services research to drive a large part of health reform, already pledging a minimum of $1 billion to the newly created Patient Centered Outcomes Research Institute (PCORI). Most physician specialties have seized the opportunity, introducing fellowships and special training programs that are producing an increasing number of surgeons, cardiologists, internists and other specialists with Master’s degrees in health services-related fields.

Radiologists, on the other hand, have remained outside of the fray, with large, multidisciplinary health services fellowships like the Robert Wood Johnson Foundation Clinical Scholars Program including a mere 1 percent of radiologists among their alumni.

“Without an increase in the number of radiologists with expertise in health services research, radiologists will continue to have virtually no input on decisions that will have drastic consequences for our specialty,” Lee and Forman argued. The authors pointed to the multibillion dollar cuts to imaging in the Deficit Reduction Act (DRA) of 2005 as well as to the revisions to the U.S. Preventive Services Task Force (USPSTF) as prime examples of policies vastly effecting the field of radiology—determined almost entirely by non-radiologist physicians.

“In fact, in all of the cases including the DRA, USPSTF recommendations and CT overdoses the radiology community has been caught responding to the issues rather than leading the discussion, partly due to our inability to show convincing evidence to support our arguments. The end result of these deficiencies is that others will dictate how radiologists practice.”

All is not lost for the specialty, Lee and Forman maintained. Modest efforts like those of the American College of Radiology (ACR) and the Radiology Alliance for Health Services Research (RAHSR) to improve radiologists’ training and involvement in health services need to be amplified, they stressed.

“Thus, for radiologists to have a more significant impact in state and national health policy, it is our belief that the subspecialty of radiology health services research must be elevated within academic radiology,” the authors argued.

“With the explosion in funding opportunities through the healthcare reform legislation and the obvious central importance this field will have in the future success of radiology technologies, academic departments of radiology can and should create sustainable divisions of health services research,” Lee and Forman insisted, an endeavor that is as yet “not on the radar of the majority of academic radiology departments.”

With the healthcare system’s need for radiologists’ input clearly demonstrated, and funding on the table, Lee and Forman argued that the ball is in radiology’s court. Radiology needs to improve the training of its specialists and add to the research on quality, appropriateness and cost.

“If we do not,” Lee and Forman concluded, “then other specialties without our inherent insights will, and we will remain on the outside looking in.”