Just like every other area of medicine, radiology is feeling the pressure of health care reform. Continuing reimbursement cuts and the shift from the traditional fee-for-service payment model to a performance and value-based model is transforming the profession.

While there will always be a need for imaging, the role of radiologists is far less certain. Lawrence Muroff, CEO and president of Imaging Consultant Inc., explains what radiologists must do to survive in this new era.

Imaging is here to stay
Two major goals under health care reform aim to prevent unnecessary readmission and shorten necessary admissions. Imaging may be able to help with that.

“Nobody knows for sure what’s going to happen with imaging under health care reform, but there is at least a strong feeling among some radiology leaders that appropriate imaging will actually increase,” says Muroff.

Certain studies can help emergency room physicians avoid unnecessary readmissions. Additionally, if a patient is admitted, early imaging with CT or MR can hasten getting an appropriate diagnosis and result in a shorter hospital stay, says Muroff.

Imaging can run into problems if it’s not done appropriately — meaning if it results in costly and unnecessary follow-up studies. But there may be a way to solve that.


More specialized training
Muroff believes that as the degree of specialized training goes up, the degree of diagnostic uncertainty goes down. For example, if a radiologist is not well-trained in neuroimaging and they spot something on a CT but are not sure what it is, they are more likely to ask for another study.

But if a radiologist is well-trained then they are more likely to have encountered that finding before and can at least offer educated speculation as to what it is rather than order another study.

“If we are going to change the way we reimburse for medical care then I think we need to also change the way we train those who provide medical care,” says Muroff. “That means training for accountability for speed, accuracy and cost and we don’t do that.”

He believes that if you ask most academic chairs what their institutions are charged for a variety of different procedures, they would have no idea. “So it’s not surprising that residents and fellows have no idea what things cost,” he says.

Health care reform is going to demand subspecialization and it starts with the way trainees are educated.


Become more significant
“Radiologists will have to show significance because if we don’t provide services that others can’t then others will basically take over our turf,” says Muroff.

Radiologists are going to have to be available to consult, be visible to the patients and integrate themselves into the medical, social and political fabrics of their hospitals and communities. If they fail to do that, they’re at risk of becoming insignificant in the new health care dynamic.

Most patients think that it’s their doctor who is reading the studies and they’re confused when they get a bill from an “unknown and unseen entity,” says Muroff. “We’ve got to be visible, we’ve got to provide a level of service that others can’t emulate unless they have the same intensive training that we have,” he says.

Muroff is hopeful that radiologists will do this. “I think, if it embraces the need to provide significance, to provide value, then I think radiology is going to thrive,” he says.