A Pollyanna Interlude
Cheryl ProvalThose who know me even a little would never peg me as a Pollyanna, heroine of the 1913 novel of the same name by Eleanor H. Porter (1868–1920): a cheerful bundle of optimism with the gift of finding sunshine in even the darkest day. Even by those closest to me, I am perceived as critical, skeptical, and too particular to be positive (in my defense, I come by all three traits honestly, as occupational hazards of 35 years as a journalist and editor). Now, I am ready to confess a deep, not-so-dark secret: 50 years ago, as I sat on a velvet seat in a darkened movie palace, Disney’s “Pollyanna” left an imprint on my as-yet-unhardened heart. Today—right now—I am letting her loose, for if ever there was a need for optimism, it is at this moment in radiology’s long winter night. Call it my year-end gift to those of you who have endured a year of scolding, bossy editorials urging you to heed the cries of the wolf at our door. Instead of writing about the atrocities contained in the 2011 final Medicare Physician Fee Schedule (MPFS)—specifically, the shortcomings of the Physician Practice Information Survey and the multiple-procedure payment reduction—as we move into the final month of the first decade of the 21st century, I offer you 10 reasons to be optimistic about the future of radiology. First, change breeds opportunity. While complacency will get your lunch (and maybe more) eaten, creativity offers the best hope for thriving. Whatever you do, don’t bury your head in the sand; instead, free your right brain and develop some coping skills for life in this age of uncertainty. Take a vacation. Imagine the future. Private-equity money has a keen interest in health care. Second, team care trumps rugged individualism in health care. No matter which direction the politicians take health-care reform, we can thank the legislation for getting health-care providers aligned around team care. This puts patients where they belong in the health-care equation: at the center. Third, the growth forecast predicts sunny skies, with a few thunderheads on the horizon. There are concerns about how utilization management will affect volumes, but forecasts from respected health-care consultancies like The Advisory Board Company (Washington, DC) call for moderate growth in high-tech imaging, moving through the decade. Growth is good. Fourth, functional/molecular imaging is a vast, untapped frontier. Don’t let the glowing-mouse images turn you off: The imaging of biological processes poses some very tantalizing possibilities for the future of the specialty. While you have some jingle in your pocket, look for opportunities to invest in the future of radiology. Fifth, prepare for low-dose CT lung-cancer screening. Just when it was lying, besmirched, in the gutter of popular consciousness, multidetector CT got a public-relations boost with the November news that the National Lung Screening Trial had been halted due to clear evidence that low-dose CT lung-cancer screening can save the lives of smokers and former smokers. Results will be published soon; start thinking about your strategy now. Sixth, fee-for-service payment is under review. Let’s face it: CMS has thrown the RBRVS system out of the window when it comes to pricing radiology services, and once it turns its sights toward the newest growth specialties, they will feel the sting, too (perhaps a new payment system would restore some semblance of equity). Because this is an exercise in optimism, we must count our blessings: Radiology continues to be an exciting, challenging, and rewarding specialty/business/domain in which to labor. Seventh, outpatient imaging is not a business for sissies, but here, also, there is reason to be hopeful. Insurers want a low-cost option, and patients want easy access to outpatient studies. These are two very good reasons that private insurers may break with Medicare and maintain fair pricing. Eighth, bridges are better than fences. As radiology engages in seeking new forms of care delivery, now is the time for building bridges, not erecting fences (check out what health-care futurist Jeff C. Goldsmith, PhD, has to say on this subject). While they are more complex, bridges are far more interesting structures than fences. Ninth, the proliferation of accreditation requirements favors radiology. As it stands, by 2012, providers of CT, MRI, and nuclear medicine will have to be accredited for reimbursement under the MPFS. California also will require providers of CT and radiography to be accredited by 2013. This is welcome, if potentially costly, news for all high-quality providers of outpatient imaging services. Tenth, while the carrot of pay for performance will soon turn into a stick, pay for performance opens the door to another idea whose time is overdue: pay for technology performance. Should a procedure performed on state-of-the-art technology be reimbursed at the same rate as one performed using a legacy machine? We think not. The essential truth is that radiology rocks the health-care house. The specialty has the best tools, the most functional IT, the greatest people, and the brightest physicians. There’s good reason to bet on this horse. Bring it on, 2011.