Letter to the Editorletter to the editor

Editor’s Note: ACR member James E. Heisel, MD, of Jackson, Mich., responded to the June ACR Bulletin article "Adapting to Change" (http://bit.ly/Adapt2Change). The article sought to explain how, given the drastically shifting medical landscape, radiologists must adapt in order to thrive. Below we’ve printed some of Dr. Heisel's most salient points, along with responses from the ACR's Imaging 3.0™ Work Group.


Dr. Heisel: The article proposes that radiology will trend toward having little or no value in the future if radiologists remain poorly understood and recognized by patients. My view is that this is simply not true. The reality is that the referring physician is our first and most important customer. Patients and hospitals are the two additional and also very important customers. As such, as long as we continue to provide tremendous value to our referring physicians and maintain good relationships with hospitals and health-care systems, we will prosper. It is simply not important that patients consistently encounter radiologists or get to know them.

Of course, patient satisfaction during visits to the radiology department is very important, but it does not hinge on a personal interaction between the radiologist and the patient (although this is occasionally necessary and useful). And let's not forget that this is another activity that no one wants to pay for. The truth is that referring physicians would generally prefer that radiologists refrain from inserting themselves into the mix and tend to view [radiologists' interactions with patients] as unnecessary interference.

Imaging 3.0 Work Group: Engaging patients in the decision-making surrounding their imaging care does not mean that radiologists need to develop a personal relationship with each patient. However, with the increasing focus on value-based and cost-effective care, it is incumbent on medical professionals to seek opportunities to increase value and decrease costs in novel ways. There is growing evidence (http://bit.ly/HealthOutcomes) that more engaged patients have better outcomes and lower costs.

Dr. Heisel raises an important point that some referring physicians may be uncomfortable with a direct interaction between their patients and a radiologist. However, we would point to the almost 20 years of federally mandated communication between patients receiving mammography services and the radiologists who provide those services. We believe that it has contributed to higher-quality care and has not been detrimental to the relationship patients have with their primary care or other physician.

Dr. Heisel: Yes, change is on the horizon, but the best approach is to stay the course and keep doing the things we do well. Radiology will succeed if it focuses on creating reports of the highest quality and accuracy and delivering them in a timely manner. Our services will become even more indispensable and essential as we continue to meet the demands for 24/7/365 real-time coverage of ED and inpatient exams. It really does not need to be so complicated. We need to stay true to proven business principles, like not giving our services away for free, not negotiating with the idea that we will inevitable lose ground, not accepting the idea that we are moving toward increased irrelevance, and not believing the assertions that so much of our imaging services can be categorized as unnecessary.

Imaging 3.0 Work Group: We can all agree with Dr. Heisel's comment that we should be dedicated to quality. However, the payments for the high-quality care to which he alludes have already begun to decline and will likely not be regained. Dr. Heisel seems to prefer that fee-for-service remain in place with no reduction in reimbursement. But in reality, unless we want to work progressively harder, interpreting more cases for less reimbursement per case, radiologists need to be prepared to move beyond interpretation. The Imaging 3.0 Work Group has evaluated many expert opinions about how the health-care system can provide the best value in patient care, and our recommendations represent our best assessment of what radiologists can do to increase the value proposition they provide.

Although medical imaging remains central to medical care, it is important not to confuse imaging with radiologists. In order for radiologists to remain central to medical care, we believe we need to exert our influence beyond just the interpretation of images. Through Imaging 3.0 radiologists will improve imaging care for all stakeholders — patients, referring physicians, and payers. Many of us would prefer to ignore the profound environmental changes that are upon us; however, doing so is not without risk.

There are many examples of individuals, companies, and organizations losing influence or even becoming extinct because they chose to stay the course in changing times. Rather than staying the course, Imaging 3.0 provides a proactive, integrated, and patient-centric approach to imaging care. If adopted by radiologists, referring physicians, patients, and payers, the Imaging 3.0 strategy provides a win-win situation for all relevant stakeholders. We urge our colleagues to look to the future — not to the past — and optimize opportunities to enhance value in all we do.

To learn more about Imaging 3.0, please visit ACR's Imaging 3.0 page at http://bit.ly/ACRImaging3 and read "Adapting to Change" in the June 2013 ACR Bulletin at http://bit.ly/Adapt2Change. Continue the discussion by logging on to the Radiology Leadership Institute Forum at http://bit.ly/RLIforum.

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