Radiology's Next Big Policy Fight

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A Q & A with noted health care futurist Jeff Goldsmith, PhD, provides insight into the specialty’s looming challenges and vast opportunities.

A conversation with Jeff Goldsmith, PhD, is, by definition, unpredictable and always provocative. Currently associate professor of Public Health Sciences at the University of Virginia, Goldsmith began his career in the Illinois governor’s office as a fiscal and policy analyst. He served as director of planning and government affairs at the University of Chicago Medical Center and special assistant to the dean of the Pritzker School of Medicine. During a 12-year stint as national advisor for health care for Ernst and Young, Goldsmith lectured on health services management and policy at University of Chicago. He also has lectured at the Harvard Business School, the Wharton School of Finance, Johns Hopkins, Washington University, and the University of California at Berkeley.

His latest book, The Long Baby Boom: An Optimistic Vision for a Graying Generation, will be published this month by Johns Hopkins University Press. He currently is working on a book about imaging and the future of medical practice with Bruce Hillman, MD, a founder and former chair of the ACR Imaging Network and professor of radiology, Health Evaluation Sciences, the University of Virginia, Charlottesville. Golds - mith graciously agreed to share his thoughts on the current challenges in radiology, as well as the future of the profession, with the readers of Radiology Business Journal.

RBJ: By spearheading the adoption of information technology, some radiology groups have vastly increased both efficiency and productivity. There have been concerns, though, that the portability of imaging will turn the service into a commodity. How can radiologists prevent that from happening?

Goldsmith: I don’t think it’s the ease of access or IT that is to blame for this commoditization so much as the fact that we have had a tremendous expansion in capacity in people and equipment in this industry in the past 15 years. If the expertise to interpret images and the technology to create those images were scarce, that commoditization wouldn’t happen. Since there is a global market for image interpretation, the way you determine scarcity isn’t just by looking at the number of practitioners in the continental United States. The way you avoid commoditization is to create new value—new technology and new expertise in exploiting that technology—to answer new diagnostic questions

RBJ: With the emergence of the distributed reading model and enhanced electronic communications, do you envision new models of imaging delivery in the future?

Goldsmith: I think we are already seeing them. I think the question isn’t imaging delivery; it is the question of what role the imaging professional plays in both the consultative and treatment processes.

Just because you can get an interpretation done from anywhere doesn’t mean that the job is done. There’s a cycle of interaction between the imaging professional and the people who ordered the test. That cycle relies on strong feedback loops and good communication. Not all of that communication is going to be electronic communication. Imaging professionals are part of a professional community, and it is how they participate in that community that really defines their role, not where they are when they read the scan.

The other thing to say is that one of the key changes in imaging technology has been its enabling the radiologist to morph into a curative as well as a diagnostic professional by connecting imaging to the treatment process. I see that curative role continuing to widen.

One example is the idea that you will have imaging in the operating room not that you will scan somebody outside the operating room or remove tissue and send it out—but that you will have imaging take place in real time, intraoperatively, in the operating suite. We’ve had this for years with transesophageal echo but that was just the beginning. The role of the imaging professional is becoming central in the provision of critical care services. It isn’t just the interventional radiologist; the idea is that you are going to have, with the emergence and improvement of functional imaging, the radiologist inside the critical care team, not just a remote consultative resource

RBJ: You have suggested that consumers’ share of high-discretion areas of health care should be increased, and you included radiology along with