Radiology practices should expect volume decreases as high as 70% for months, experts say

Radiology practice leaders hoping for a quick end to ongoing business disruptions during the COVID-19 pandemic might be in for a big disappointment.

Based on anecdotal evidence and experience at their own institution, two Yale radiology experts believe businesses should expect at least three months of “dramatically reduced imaging revenue.” And those drops could range anywhere from 50%-70%, with outpatient imaging providers hit hardest, they wrote Wednesday in Radiology.

“Radiologists are facing an economic crisis with a severity and length that few could have imagined,” report co-author Joseph Cavallo, MD, from Yale School of Management, said in a statement issued April 15 by RSNA. “Practices will need to make short-term sacrifices to ensure solvency, stay agile enough to handle a quickly changing and uncertain fiscal environment, and be prepared for potentially permanent changes to the field moving forward.”

Cavallo and co-author Howard Forman, MD, MBA, noted that their state’s Department of Health has predicted a peak in regional cases the first week of May. During the start of the pandemic in mid-March, Yale began rescheduling nonurgent imaging, with more pressing studies subject to “increased scrutiny regarding their necessity.” Preliminary data from the school’s academic multispecialty radiology practice notes a 70% drop in outpatient imaging since then, with a 50% dip in emergent and inpatient services.

Adding an extra month of recovery, they’re expecting three months before things return to some semblance of normal. However, absent a COVID-19 vaccine, business interruptions could continue into 2021, they noted.

“It is not out of the question that some degree of lockdown could continue for the next nine months or longer, however, responsible policy decisions coupled with increased testing may allow for some semblance of normal operations even during that period,” Forman and Cavallo wrote.

In the meantime, provisions of the CARES Act can provide practices with relief. Hospitals are slated to receive some $100 billion under the stimulus bill. And rad groups could also tap into $500 billion in loans available through the Treasury’s Exchange Stabilization Fund.

However, the two Yale writers recommend that practice leaders—if they haven’t already—make smart business moves to weather the COVID storm. Reducing work hours, temporarily cutting salaries, suspending bonuses and furloughing workers are just a few of their suggestions. When the economic climate does finally return to “normal,” it’s likely the specialty will never be the same, the authors wrote. Patients will come to demand more virtual care; radiologists will want to continue working from home; and patients likely will not tolerate practices that are only open from 9-5.

Radiology may become a less desirable profession for some, given the COVID shakeup it’s going through, and more practice leaders may eye selling their stakes to get out of the imaging game.

“It is our hope that legislators can offer additional help for the unpredictable times ahead,” Forman and Cavallo concluded. “Ultimately, it will be a combination of the publicly provided aid and individual managerial decisions by radiologists that determine what our practice environments look like in 2021 and beyond.”