Twenty years. That’s the time it took for hospital radiology departments in the United States to fully convert from film-based to digital operations. These years spanned an era that witnessed the introduction of RIS, PACS, archival silos and cloud storage, electronic image exchange, digital dictation and an onslaught of advanced 3D, 4D and quantitative informatics software innovations. Radiologists and their departments adapted, adopted and survived.
Now the challenge is value-based healthcare: healthcare provider services that positively impact patient outcomes and the purse strings of payors. How will this impact the radiology department of the future? Radiology Business Journal asked leaders in four healthcare organizations with reputations for innovative thinking to discuss the major forces reshaping healthcare and their implications for the hospital radiology department as it exists today and then to do some crystal ball-gazing into the future five to 10 years hence.
It’s not just the Affordable Care Act that is impacting healthcare. Jonathan S. Lewin, MD, identified three overriding forces reshaping healthcare within the United States that exist in parallel with the mandates of healthcare reform from the Obama Administration. These are:
- The financial necessity to reduce the healthcare expense burden on individuals, companies and other payors, and the society at large;
- The increasing rise of consumerism in healthcare; and
- The steady evolution and expansion of instant communications, particularly mobile technology, resulting in heightened patient expectations.
Lewin should know. In addition to being a professor of radiology and chair of the department of radiology and radiological science at Johns Hopkins University and radiologist-in-chief at Johns Hopkins Hospital in Baltimore, he also is the healthcare enterprise’s co-chair for strategic planning and senior vice president for integrated healthcare delivery at Johns Hopkins Medicine.
“These forces are converging on healthcare, all striking at the same time,” he says. “They represent huge challenges for healthcare delivery systems. We as a country are running out of money to pay for escalating healthcare costs and so is a typical family’s budget. Now that most individuals have a direct stake in keeping healthcare costs down because they pay a higher proportion of them, they are becoming better educated and demanding transparency.”
Lewin believes that decades of escalating healthcare costs are in great part attributed to the rise of Medicare and commercial health insurance negotiations with providers that separated patients from any price consideration. Dieter R. Enzmann, MD, professor and chair of radiology at the UCLA David Geffen School of Medicine in Los Angeles, agrees, pointing out that because third parties negotiate fees for healthcare services, most healthcare providers and radiology departments have evolved into service departments whose practice innovations have concentrated on increasing service volume rather than service value. Only recently have patients questioned the types of radiology exams being ordered, and asked why they were ordered and how they would help, what they cost and why costs differ among providers.
Internet technologies have had a hand in this transition by revolutionizing access to information. Mobile technology, particularly smartphones, has personalized it. The opportunity to use mobile technology to monitor a person’s state of health and to provide interactive feedback is expected to have a huge impact on how healthcare is delivered. Lewin predicts that apps will raise the expectations of patients, and that the healthcare delivery systems that address patient/consumer expectations will be the ones that survive in ensuing decades.
The value-discipline approach
Addressing expectations represents value. The value-discipline approach, as explained by Enzmann, uses three market-based categorical positions: delivering operational excellence/or low-cost services, being a product leader and offering customer intimacy. He believes that most large healthcare systems will adopt a low-cost service provider value discipline that will push radiology practices to conform by offering the lowest price for their services at an acceptable quality. This will require radiology departments to adopt or improve upon strategies for high-capacity utilization of department resources, high labor efficiency, shortened production time, standardization, and