Q&A: The Year in Review

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 - Richard Duszak, Jr., MD
Richard Duszak, Jr., MD

What a difference one day makes, let alone one year. How true it is for radiology, too, with changes coming around the clock, many at lightning speed. Evolving payment models and payer requirements, evolving technologies, and new clinical guidelines and healthcare policies—blink and you risk missing the next big thing. 

To reflect on 2017’s many trends and topics, Radiology Business Journal turned to two thought leaders: Richard Duszak, Jr., MD, of the department of radiology at Emory University in Atlanta, and Geraldine McGinty, MD, MBA, vice chair of the American College of Radiology (ACR) Board of Chancellors. Here is what they think about some of the most impactful happenings of an especially busy 2017. 

What was the single most important issue in radiology in 2017? 

Richard Duszak, Jr.: We’ve entered into an era of profound change for this specialty. From my perspective, the biggest story was the way radiology has responded to that change. We’ve moved into an era of patient centricity in healthcare that is still gathering momentum. Collectively, we’ve seen radiologists begin to move out of the reading room and in front of patients, either directly or through better patient portals and better communication with referring physicians. 

Additionally, radiology has been at the forefront of developing and promoting new payment model proposals and identifying quality metrics that work best for radiologists and our patients. It’s exciting to see radiology’s thought leaders move the specialty forward and react positively to these changes instead of being passive participants in that process. 

 - Geraldin McGe inty MD, MBA, Geraldin McGe inty MD, MBA

Geraldine McGinty: The impact AI and machine learning will have on healthcare and specifically radiology has been a topic of intense interest for several years. The launch this year of the ACR’s Data Science Institute was a clear statement that this is a critically important time for radiologists to stake their claim as the stewards of medical imaging and to articulate our role as advocates for our patients as these disruptive technologies evolve.

Some experts think deep learning and AI technologies could replace radiologists sooner than later, but there are others who argue radiologists will adapt and use AI to their advantage. What do you think? Has your opinion about this changed over the years? 

Duszak: I think we all have a lot of reasons to be fearful, and humans tend to fear the unknown, but as I have talked more to radiologists and experts in other industries, I have become much more optimistic about the role of AI. As long as we, as a profession, are willing to take the lead on this, we can make it work for radiology. 

Some of what has resonated with me is talking to friends of mine who are pilots. The older ones shared their earlier fears of being displaced when autopilot first came out. They all still have jobs today, though those jobs have changed. The computers are now taking care of the many routine things that previously were distractions, so they’re able to function at a higher cognitive level. 

As long as we look at AI as a tool that enables us to do better, but remember we’re the captains of the radiology workflow, I’m very optimistic about the opportunities that these new technologies will create. Sure, it will seem disruptive at first, but I’m optimistic that it will make us much better. Radiology has always done well in implementing new technologies, it’s just that this particular one is being imposed on us instead of us imposing it on others. 

McGinty: I am excited about how these technologies can augment the work that we do as radiologists. I believe that the benefits offered by AI far outweigh the negatives as we think about expanding the global reach of what we can offer patients as well as increasing the accuracy and reliability of each study we interpret. 

With that said, the promise of IBM’s Watson has been largely unfulfilled despite its access to millions of images and significant investments by many healthcare systems. So I’m committed to an active review and exploration process with a stringent requirement for performance beyond the hype.

Radiology’s shift to value-based care continued throughout 2017, and it’s still a work in progress. If you were to give the industry’s ongoing transition a letter grade for its efforts thus far, what would it be? Why?

Duszak: Since I’m not giving a grade to any particular student, if you will, but the entire class of radiology, I would have to say a B. There are some who deserve an A+, but there are others who deserve an F. The ACR as a whole, and specifically its economics team, earned a really high grade. They were able to recognize long ago that radiologists would need to participate in registries that would ultimately be recognized by CMS as Qualified Clinical Data Registries, and they set up many registries so that they would all be successfully adopted. I also want to give a pat on the back to the team at the Harvey L Neiman Health Policy Institute. Everybody’s talking about new payment models and because of that team’s work, radiology has a very meaningful seat at the policy table. Some radiology practices have done a great job in this space, doing a superb job preparing for MACRA and MIPS.

But there are also a lot of practices that earned a much lower grade, either because they aren’t aware of the various changes or because they’re aware, but they just don’t want to change. Those folks would get anywhere from a C to an F. 

To continue this metaphor about grades, our entire class had its syllabus change in November 2016 with the election of a new president. The new administration is slowing the tempo of value-based payments moving forward, which will slow down some of these initiatives. But that might actually be a good thing for those who aren’t ready, giving them more time to improve. 

McGinty: I’d give us an A for the work we’ve done in building registries that allow radiologists to benchmark their performance against peers and submit their data to Medicare to comply with the agency’s various performance programs. We’re far ahead of other specialties. 

We can always improve the process of data submission and I’d challenge our EHR vendors to work as effectively with us as our equipment vendors have. Also, we need more outcome measures. That’s a challenge across healthcare, but it is especially important for us in radiology so that we can prove the value of our contribution to healthcare.

Insurance giant Anthem made headlines this year with its new policy that pushes outpatient imaging outside of the hospital and into freestanding imaging centers in several states. Did this policy surprise you when it was first announced? What are your thoughts about the policy?

Duszak: I was not surprised that Anthem moved in this direction because they were continuing what CMS and others have been doing in their move toward site-neutral payments. They’re effectively asking, “Why should we be paying more for the same outpatient CT scan in a hospital than we pay at an imaging center?” I think some of this does dial up the transparency for how hospitals bill these services, and health systems need to be having honest conversations with the insurance companies about these costs. 

That said, I was surprised with the drastic “take it or leave it” way they did it and how it was rolled out in a manner so unfriendly to patients. This policy came out at essentially the same time as another one that would allow Anthem companies to play “Monday Morning Quarterback” with emergency department visits. If someone goes into the emergency department (ED) and what they thought might be a heart attack turns out to just be indigestion, the company seems to want to say, “We’re going to make the patient pay for the visit because he or she didn’t have a crystal ball.” I understand we don’t want patients to abuse the ED, but I’m afraid all of this starts to put us all down a slippery slope where patient care suffers. 

Hopefully, Anthem will recognize that what they’re proposing with imaging will disrupt existing patient and physician relationships, prompting them to back off a bit to instead pursue meaningful conversations with hospitals about how they price out services. To just broadly stop paying for outpatient services could fragment patient care in a terrible way.  

McGinty: I think insurance companies have no business getting in the middle of the relationship that patients have with their physicians, including interfering in the physician’s decision to recommend an imaging facility where they feel the patient will get the best imaging care. Whether it’s about loss of continuity of care for a patient with a chronic condition or the lack of collaboration between referring and performing physician around the choice of imaging, this policy misses the point on quality of care. Do I think we need to be transparent around pricing? I do. Do I think we need to clearly communicate what it costs to invest in state of the art equipment and training for physicians and staff so that our patients benefit from the most up to date imaging? Absolutely.