Great Expectations

Challenging ourselves to meet the service expectations of our patients.Great Expectations

I came across an opinion article in the New England Journal of Medicine that I thought had some valuable lessons for radiologists.

The article by David A. Asch, MD, MBA, and Kevin G. Volpp, MD, PhD, discussed the bankruptcy of photographic film giant Eastman-Kodak.1 Among the reasons given for the once great company's demise was the fact that Kodak was late to recognize that it was not in the film and camera business; it was in the imaging business. Rather than adapting to the changing marketplace, which was rapidly moving away from film, Kodak continued to do what it had always done and eventually became obsolete.

While we in radiology currently see ourselves as being strictly in the imaging business, going forward we will almost certainly need to recast this view to encompass the evolving needs and expectations of our clients. Our business is indeed diagnosis and sometimes treatment, but today's equation must also include excellent service to our clients.

As radiologists, we have two types of clients: referring clinicians and patients. With the development of PACS systems that offer web portals and instantaneous report generation using voice dictation, we have gone a long way toward meeting the changing needs of our referring physicians, although we certainly have additional opportunities especially around decision support.

In this month's column, I'd like to focus on how we will need to adapt to meet the need of our other client base: our patients. Many of our patients now book travel through airline websites, shop online, and manage their finances through secure web portals provided by their financial institutions. If we are to meet their imaging needs effectively, we too must provide them with robust online tools and resources.

Contributing to the changing expectations of our patients is the growth in the number of patients who pay for their imaging services out of pocket. According to a census report from the America's Health Insurance Plans' Center for Policy and Research, the number of people enrolled in high-deductible health plans has increased from 1 million in 2005 to more than 11 million in 2011.2 This has a significant effect on how we as providers are paid. Collecting from patients is harder and more expensive than collecting from payers.3 In my own practice, I have observed that levels of bad debt write-offs are also higher for patient responsibility dollars. Even as patients are expected to pay more of their health-care costs through higher deductibles, their benefit plans are changing in other ways, including by linking reimbursements to Medicare rates rather than using traditional "usual and customary" rates. Such actions result in lower payments in general and can lead to sticker shock for patients, especially those who choose to seek out-of-network care. Organizations such as Fair Health ( and websites such as Leslie's List ( provide calculators and tools to help patients understand the average charge they should expect in a particular geographic area.

As our patients pay a larger contribution towards their care, it is not surprising that they expect higher levels of service. But what does service mean to a patient when it comes to imaging? As I explained in my June column, payers and radiology benefits managers may favor lower cost over quality improved service and are prepared to share their savings with patients who chose cheaper facilities. We as imaging providers know that this perception is flawed and quite possibly detrimental to care, but our challenge is to demonstrate quality and service in a way that is relevant to our patients.

The ACR senior leadership has recently engaged in a robust examination of what it will take to ensure the value of radiologists for the future of health care. Among the many themes explored in an upcoming ACR strategic initiative (whose working title is "Imaging 3.0") is the need for radiologists to connect with their patients in a way that makes the value of what we do crystal clear. This will require making images portable and available in secure but easy-to-access formats, discussing imaging findings collaboratively with patients' and their various providers, while at the same time making sure that the patient experience inspires confidence and comfort.

With the many cuts to our reimbursement, it can be difficult to think about ways to improve the patient experience, by many of the service innovations that we enjoy in other parts of our daily lives have actually reduced our expenses. When I can book a multi-city flight, reserve a rental car, and make hotel reservations with only a few clicks of the mouse, why do I have to spend my time booking an appointment for a screening mammogram over the phone? Providing online scheduling can obviously can also reduce a practice's expenses although it will not be suitable for all types of examinations.

With the requirement for accountable care organizations to have patient representation in their governance and with patients posting reviews on their doctors' performance on sites such as Healthgrades ( and Angie's List (, it is incumbent upon us to ensure that, as radiologists, we make sure we are indeed considering the comfort and safety of our patients over our own convenience. Only then can we demonstrate the value of the care that we provide.

To view endnotes, visit

Geraldine McGintyBy Geraldine B. McGinty, MD, MBA, Chair

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