Meet the Moreton Lecturer
Jeffrey C. Bauer, PhD, gives a sneak peek at his ACR 2017 session — and his take on the future of health care.
Health futurist and medical economist Jeff Bauer, PhD, recently talked to the ACR Bulletin about his upcoming Moreton Lecture at ACR 2017, Forecasting Futures of Radiology at the Crossroads: It’s All Downhill from Here on Up.
Why do you think you were asked to speak at ACR 2017?
Uncertainty about the future of health care is arguably at an all-time high, and I have been dealing with it for most of my 40-plus-year career as a professor of statistics and research at two medical schools and as a vice president of health strategy at two Fortune-500 companies. I’m proud of my batting average in identifying major changes before they have occurred and proposing how to prepare for them, with a special interest in radiology. At ACR 2017, I will describe the two very different ways in which I have been trained to look ahead: trend-based predicting and possibility-based forecasting. I’ll explain why the future of health care is now unpredictable because today’s forces of change are not the same as those that shaped it in the past. I’ll then apply the art of forecasting to show the new realm of possibilities that radiologists can harness to create a variety of different futures.
In effect, I’ll be drawing on my original training in atmospheric physics to show why we should look at health care like meteorologists look at the weather — something very different from the way health policy wonks look at medical care. To avoid the trap of talking about the weather but not doing anything about it, I’ll propose several specific actions that radiologists can take to prepare for the climate change that is transforming just about everything we thought we knew about health care based on past experience.
How do you see this transformation playing out for radiologists?
There should be real excitement around alternative futures for radiologists who are willing to create new approaches to the art and science of their specialty. The future can be good for those willing to figure out how to combine technology and medical science, build relationships with other physicians, adopt alternative payment models, and assume leadership roles — not just within diagnostics but throughout the health care delivery process. Oncology provides a good example of specialty transformation, from the impossible goal of curing all cancers as discrete diseases to the feasible goal of managing tumors as they evolve based on patient-specific factors. Radiology must similarly address the incredible complexity of pathologies that have the same appearance but different biological instructions.
Does this comparison mean that teamwork is in the future for more radiologists?
Absolutely. Radiologists can become more valuable for lots of other medical specialists. However, I think the most exciting opportunity is what I call diagnostic convergence — working with pathologists to create a unified diagnostic science. Just as radiologists have done an exemplary job eliminating waste within imaging, imaging and laboratory medicine should formalize efforts to eliminate waste across the two specialties, to figure out the most appropriate diagnostic test when both specialties have one or more to offer.
ACR long ago realized that patients were sometimes getting studies that were not indicated by overall clinical circumstances. The organization deserves real praise for developing its ACR Appropriateness Criteria® that provide guidance on what type of imaging to order for a given clinical condition. This focus on efficiency and effectiveness is a special key to success now that health spending has quit growing — another topic I will cover in the Moreton Lecture. Radiologists can be the leaders for the whole diagnostic realm, just as they are in eliminating unnecessary, redundant imaging tests. This is the idea of diagnostic convergence. It’s looking at what imaging professionals can contribute to the whole health care system in terms of clinical excellence within real economic constraints.
So if radiologists lead the way, it sounds like they can’t be replaced.
No, I don’t see anyone or anything replacing radiologists, unless they let imaging become a commodity that any other specialist can use because radiology amounts to nothing more than taking and interpreting an image. Other specialists want to know more about imaging findings. They want to see what is going on in the body. They want more than a cold, two-paragraph report that mentions something peripheral to a condition. Radiologists can help themselves, in part, by making the importance of images clear to other doctors. Imaging 3.0® is a great step in this direction.
Since we’re talking about the future of radiology, what would you say to medical students interested in entering the specialty?
I think it is a great specialty, but it must address problems, like burnout, inherent in commoditization. The good news is that imaging has attracted some of the smartest and most innovative people in medicine and should continue to do so because diagnostics offers so many opportunities for innovation. It’s probably the most tech-savvy, tech-oriented specialty you could choose. However, medical students considering the specialty should understand that future radiologists will be much more involved in interpersonal contacts with other physicians, patients, and health system managers.
Any final thoughts on what should happen next within the health care system in general?
The overall goal of health care should not be simply for more people to have insurance. We also need to get more bang for our buck. The governments and employers who pay 80 percent of health care bills are no longer willing or able to increase spending year after year. We should be creating the healthiest population that 17.8 percent of the GDP can buy. Roughly 17 cents of each dollar spent in the U.S. on final goods and services is spent on health care. And we get an abysmal return on that. Radiology can make major contributions to achieving the goal of cost-effective health care serving a healthier population.
The Morton Lecture will take place during ACR 2017, May 21-25 in Washington, DC.