The Future of the Practice of Radiology
I have great optimism for the survival of the practice of radiology. I believe that many groups will thrive, and that there is the opportunity for continued professional satisfaction. For many of us, however, success will need to be redefined. There are many changes occurring around us. In the region where I practice, the two largest hospital competitors have just merged. My group is one of six to serve this new regional system, and we will not know the impact of this for two to three years. Therefore, we not only are facing the reimbursement issues affecting the rest of the country, but the stability of our contracts is at issue. While we need to make every reasonable effort to maintain our income, I have accepted that it will decrease. The federal government is bankrupt, so Medicare cuts are inevitable. My state, like most, is running deficits, and Medicaid is being cut. At the same time that we are trying to maximize our payments from the private insurance companies, every business owner I have spoken to is trimming the offerings in employee health plans and increasing copayments for the recipients of care under those plans. We have several Fortune 500 manufacturing and software companies in our area—and they are all making similar decisions, so that bucket has a bottom as well. In addition to decreases in the revenue available to fund all of medicine, RVUs are being shifted from imaging services toward primary care. Many groups have responded to declining revenue by focusing on productivity. This has helped many groups blunt the impact of declining reimbursements. If we focus on productivity to the detriment of service or quality, however, it will hurt us. If we don’t answer phone calls from our referring providers and hospital administrators, sooner or later, the phone will stop ringing, patients will stop being referred, and the contracts will run out or be terminated. Why, then, am I optimistic? I know that appropriate imaging adds value to the treatment of patients. I know that hospitals and referring physicians need our help to serve their patients, and most referring physicians and hospital administrators know that they need us. There can be a significant disconnect, however, between what they want from us (and consider their needs to be) and what we deliver to them—despite our best intentions. The Problem and the Solution The problem is knowing what it is that they want from us. We need to be humble enough to ask those we interact with what they want—and not just in the context of what our groups can now offer. What would the ideal radiology group provide to them and to their patients? The answers we have heard include 24/7 neuroradiology coverage, a defined musculoskeletal pool with extended hours of coverage, timely reports (defined differently by each respondent), dedicated mammographers, 24/7 cardiac imaging, oncologic imagers, documentation of quality greater than RADPEER™ allows, utilization management, and even IT support. What you find when you ask might differ, but if you value your relationships with the hospitals that you serve, you need to ask the questions. As most business/marketing people will tell you, if you ask someone what he or she wants, you have to be prepared to act. I know that my radiology group cannot meet these stated service goals, and we will need to get significantly larger. If you are unwilling to ask a question because you are not ready to act on the answer, chances are that the national groups have already asked it—and if they haven’t, they soon will. In fact, this has happened to us. The primary reason that we have held off these attempted incursions was our involvement in our medical communities. My group has made a concerted effort to have good relations with the hospitals that we serve. We sit on the medical executive committees of multiple hospitals; we serve on IT, credentialing, and quality committees; and the current presidents elect of the medical staff of two of our hospitals are members or our group. Because of our contributions to, and relationships with, the hospitals that we serve, we are informed when there is a threat to our service sites by other groups (such threats have come from both regional and national groups). Having strong relationships at multiple levels in the hospitals that we serve is no longer optional. Sitting on the sidelines is no longer possible; we must become indispensable. If we define success as maintaining the income levels that we currently enjoy, with a 5% to 10% increase every year, we are going to be very frustrated. I choose to define success as having strong, stable relationships with our hospitals and referring providers, along with the opportunity to have a meaningful impact on the patients we are fortunate to serve. I know we can achieve this. What will be required for success? Have strong political ties with your hospitals, ask your hospitals and referring providers what they want from you, and be prepared to meet their requests for expanded services. Become an active partner in helping them plan for (and negotiate) the coming changes. Pay attention to optimizing efficiencies and productivity, but do not lose sight of the need to serve on hospital committees, to present at hospital conferences, and to find reasons to talk to referrers and patients. Richard Satre, MD, is president of Radia, an 80-physician radiology and vascular-surgery practice based in Everett, Washington.