One of the greatest threats facing professional organizations such as the ACR is the pursuit of increasing margins. The term margin refers simply to the ratio of an organization’s revenues to its expenses. When professional organizations begin to make margins their top priority, they risk compromising their loyalty to mission. One of the most reliable signs that such an organization is well led is a willingness to forgo increasing margins in defense of its fundamental priorities. Consider, for example, the cautionary tale of the AMA’s pursuit of greater margins. In the 1980s, the AMA copyrighted its Current Procedural Terminology (CPT) code set, which was soon required by nearly all health care payment systems. Soon the AMA was generating far more revenue from CPT codes than from member dues. Over this same time period, AMA membership as a percentage of practicing physicians declined substantially. Many factors were likely involved, but one of the most important may have been mission drift. Rightly or wrongly, some AMA members perceive that the organization evinces greater loyalty to its margins than its members. The CPT coding business is hugely profitable to the AMA, so much so that the organization frequently revises and increases the complexity of the codes themselves, thereby augmenting demand. Such a strategy appears to be beneficial for the organization’s bottom line, but from the standpoint of most of its members, increasing complexity and rate of change only make the practice of medicine more difficult. Simply put, the AMA is attempting to serve multiple masters—not only its members but the health care organizations that pay fees for its CPT codes and the federal government that continues to mandate their use. Were a group of hospitals, health insurers, or federal agencies to covet the AMA’s support for a particular policy initiative, they might leverage the organization’s dependence on revenue sources, such as CPT codes, to exert influence. In some cases, such pressure might even override the points of view of AMA members. An even more glaring example of a divergence from member priorities was the 1988 decision by the AMA to endorse items such as humidifiers and ice packs for consumer manufacturer Sunbeam, despite the fact that it would not test any of the firm’s products. This turned out to represent one of the most embarrassing chapters in the organization’s century-and-a-half history and ended up costing the AMA nearly $10 million in settlement fees. Somehow the organization forgot that its primary mission is not to generate revenue but to serve its member physicians and promote patient care. Could the same thing happen to the ACR? Suppose, for example, that the ACR perceived that the shift of large numbers of radiologists from self-employment to hospital employment was exerting downward pressure on its number of dues-paying members. Such a scenario is not implausible—the transition to an employment model is often associated with a reduction in the funds radiologists have available to pay professional dues. If membership rates began to decline, would the ACR look elsewhere to generate more revenue? Would the ACR explore new membership models, such as allowing the hospitals and health systems that increasingly employ radiologists to become dues-paying members? Although such a move might appear to make great fiscal sense, it could also ensnare the organization in potentially erosive conflicts of interest. Like the AMA, the ACR might find itself adopting and promoting policies that do more to serve the interests of hospitals and health systems than those of radiologists and the patients and communities they serve. It takes real grit to resist such siren songs, and such dedication is exactly what is called for on the part of the ACR’s leadership. When contemplating margin-enhancing opportunities, the organization needs to ask itself some difficult questions: Is an opportunity to generate more revenue consonant with the best interests of ACR members and the constituencies they serve? If such opportunities threaten to create tension between the organization and its members, could members count on the ACR to have the clarity of purpose necessary to resist them? When it comes to the vitality of professional organizations, there is more at stake than the size of membership rolls, revenues, and operating margins. Also at stake is the integrity of the organization, its members, and the profession of medicine itself. Professional organizations such as the ACR naturally seek to grow, but growth should never trump professional integrity. Ultimately, the size and revenues of an organization are less important than its loyalty to its members, whose priorities should always supersede margin and serve as its guiding light.
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Nov 17, 2022
Chao Li + 2
Open Access