Summer Reverie and Olympic Dreams
August is the sweetest month. The Pacific Ocean is finally warm enough to swim in, the tomatoes are ripening faster than I can eat them, and I give myself permission to slow down a bit and to spend an extra half hour reading the newspapers in the morning. The news is not appearing less frequently just because it’s summer, of course—and it is certainly no less important than news that arrives in any other season. For instance, the proposed 2013 Medicare Physician Fee Schedule¹ (and its latest litany of plagues for the sector), the eagerly anticipated results of the ROMICAT II study² of cardiac CT, and the final stage 2 meaningful-use rule3 for health IT all arrived this summer. These days, health care news typically foreshadows change, and change raises hackles and translates into resistance—unless, of course, it’s news of a delay, such as the August 24 announcement4 that CMS would delay the deadline for implementation of ICD-10 coding until October 1, 2014. As I write this, September presses in, signaling a return to business as usual; it is, now or never (I tell myself), time to take a break from current events and dream a little. Before we do, let’s scroll through the activities of the past several months for some perspective. Early this summer, at the RBMA 2012 Radiology Summit in Orlando, Florida, Radiology Business Journal publisher Curtis Kauffman-Pickelle and I were privileged to moderate a roundtable discussion with a panel representing a cross section of radiology stakeholders: practice, hospital, and imaging center. My takeaway was this: No physician, practice, or hospital is an island. Successful health-care providers will confer, collaborate, and align with other providers and stakeholders to create new, more efficient (and effective) models of patient care. This is happening much faster than anyone would have imagined, even last year. Two weeks later, I was back in Orlando for the annual meeting of the Society for Imaging Informatics in Medicine (SIIM), where Radiology Business Journal presented the awards to the recipients of the Top 5 Medical Imaging Informatics Projects of 2012,5 selected by a SIIM panel of medical-imaging informaticists. The winning projects moved the specialty forward by finding new ways to access and use the huge quantity of digital information that is produced, analyzed, and stored by the medical-imaging specialties. My takeaway: Imaging informatics is radiology’s sword in the stone. A month later, I had a nonpareil summer-camp experience at the inaugural event of the Radiology Leadership Institute at the Kellogg School of Management, located on the summer-lush campus of Northwestern University. Under the leadership of Cynthia Sherry, MD, the ACR® and its staff invested many resources and much thought in developing a certificate program designed to provide participants with the competencies required to lead health-care organizations. My takeaway: This program is a tremendous gift to radiology—all of radiology—and its value will be enhanced if all radiology stakeholders engage as participants. In August, I was in Orlando (again) for the 40th Annual Meeting and Exposition of the AHRA. Aisle conversations echoed many of the issues and concerns that I had heard elsewhere this summer: Veteran leaders are ready to retire, and no one is ready (or willing) to take the baton. I was surprised to encounter more than one highly skilled senior radiology administrator who had been the victim of balance-sheet restructuring at more than one large, nonprofit health-care organization. One keynote address was the equivalent of ice water to the face: Brian Klepper, PhD, a confessed partisan of primary care and chief development officer of WeCare, an on-site primary-care clinic and medical-management company, announced that he had just cut a deal for $450 MRI exams in Lafayette, Indiana. He referred to the AMA’s RVS Update Committee as the beating heart of the US health-care crisis. My takeaway: Toto, we’re not in Kansas anymore. Before I sign off, let’s get back to dreaming; it’s a great opportunity to imagine a better future—not a worse one. This summer, during the opening ceremony of the Olympic Games, the world watched as the United Kingdom celebrated its greatest contributions to society: Shakespeare; the Industrial Revolution, which resulted in a tenfold increase in the world’s per-capita income6; children’s literature; and the physicians, nurses, and other caregivers who compose the National Health Service. It was a great sight and a rare demonstration of hero worship for the medical specialties and the people who keep the doors open at hospitals and physicians’ offices. It is a dream worthy of a great civilization. In these pages, you will read about how, in the United States, we cannot afford the health-care promises we’ve made, let alone the act of extending health-care benefits to all citizens—but right now, we’re dreaming.