Masters of Radiology Panel Discussion: Responding to Health Care Reform and Other Market Pressures

Abstract

M. C. Javitt is an unpaid consultant to Code Ryte and her husband owns stock in Code Ryte. H. Hricak owns stock in Hologic. D. B. Larson is a case contributor to Amirsys and is reimbursed on a contract basis. IntRODuCtIOn. Each quarter, the AJR will publish the transcripts of the Masters of Radiology panel discussion hosted by Dr. Howard P. Forman and Dr. Marcia C. Javitt. The panel will review topics of importance to the field of radiology and share their unique insight into how these issues are shaping or will shape the future of the specialty. Forman: Today’s topic is how radiology practices should respond to the possibility of health care reform and other pressures facing radiology. Our panel was chosen based on specialty, career stage, or institution type. Our goal was to provide representation across the specialty. I’d like to start with how practices are responding to health care reform and to what extent you believe we need to embrace efficiency. Is it good, bad, or does it make no difference in our practice? Crowe: There’s a conflict between what drew many of us to medicine and the way we are often forced to practice today. Hyperefficient practice is necessary, but it is often synonymous with spending less time with patients and referring physicians. If your practice is driven solely by economics, it is a wonderful example of why economics is called the “dismal science.” This outlook fundamentally threatens the more enjoyable features of medicine and is one thing that I think is critical to maintaining one’s love of the field—feedback from one’s colleagues and interacting in ways in which teams or groups of people function to make patients better or systems better. So I’ll throw that challenging idea out on the table and let others share their opinions. Messinger: I have a little different philosophy on that. In my experience, those physicians who want to maintain a relationship with you by seeing you in person or on the telephone do it. Those who do not, haven’t and probably won’t. I appreciate what Jack said, but I’m not too concerned, at least in my practice, about that aspect of the pattern of hyperefficiency. Hyperefficiency by its very name should be good and probably is good in many respects. I am concerned, however, about how this trend is going to affect our workforce. Will it decrease the number of radiologists we need? If it does, how does that impact medical schools? Several years ago, we had more people saying “you don’t go into radiology anymore,” and that diminished the quality of our candidate pool. Now we’re seeing outstanding candidates, but I’m concerned that by becoming hyperefficient, relying so much on technology, and by trying to maintain a set income we’re going to try and “make do” with fewer radiologists. Javitt: My response is bound up in how I view our business as well as our responsibilities. Our work product is a report and that report does not reflect how much time it took to generate it or what cognitive skills were required to make it. But that is essentially the product by which our productivity and efficiency are judged. And my view is very grim because I think the hyperefficient practice we’re about to increase and promote will not equate cost and value; they’re actually at odds with one another. I think we’re solving for a cost-efficient system, not necessarily a system that places a value on accuracy or on the intangible things that we do as radiologists to take care of patients and the places where we interact with them. We need to marry cost and value to solve for hyperefficiency. Larson: A major source of this problem is that the reimbursement environment for radiologists provides strong incentives for productivity and weak incentives for quality. Individual radiologists and groups are financially penalized when they take time to focus on difficult cases, defer to subspecialists when appropriate, or work with hospitals to make system improvements. Many politicians and health policy analysts are starting to recognize this as a problem Forman et al. Masters of Radiology Panel Discussion