Threats, opportunities challenge radiologys future

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Making predictions about the future is easy; having them come true is a whole different matter. According to Dr. Frank Lexa, most of the predictions made in the past 20 years forecasting the future of diagnostic radiology have missed their target by a wide margin. Lexa, a neuroradiologist and professor of radiology at the University of Pennsylvania Health System in Philadelphia, delivered the keynote presentation on the crises facing radiology at the opening ceremony of the American Healthcare Radiology Administrators (AHRA) annual conference in Kissimmee, Fla., on Monday morning.

“In 1980, the Graduate Medical Education National Advisory Committee predicted a 34 percent surplus of radiologists in 2000,” said Lexa. “As recently as 1994, the Council on Graduate Medical Education predicted a 60 percent surplus of radiologists.”

According to Lexa, there are five factors creating both threat and opportunity for the practice of radiology in the coming decades:
1.    Disruptive technologies
2.    Reimbursement
3.    Demand for radiology services
4.    Supply side fluctuations
5.    Changing customer expectations

Disruptive technologies are not about quantum leaps in technical capability, Lexa said. Rather, they are typically simpler, cheaper alternatives to sustaining technologies with less capabilities, worse performance, and lower margins. Although this seems counterintuitive, Lexa explained that part of the growth of in-office imaging by non-radiologists has been fueled by the availability of less-expensive, anatomic-specific systems.

Reimbursement for diagnostic imaging will more than likely continue to experience downward pressure, Lexa indicated. He cited U.S. Centers for Medicare and Medicaid (CMS) statistics reporting a 22 percent increase in radiology spending from 2004 to 2005 as providing impetus for short-term cuts. In addition, macroeconomic pressures from looming funding deficits for Medicare and Social Security benefits are driving long-term imaging reimbursement adjustment strategies, he noted.

Demand for radiology services, as well as all medical services, should continue at a double-digit growth rate through at least 2020, Lexa said. He cited an aging demographic, a heightened demand from consumers and referring physicians for increased certainty, and a general defensive posture by the medical community as drivers for diagnostic imaging demand.

However, this growth in diagnostic imaging may not be to the benefit of radiologists. Lexa noted that the largest areas of growth in imaging are from non-radiologists, with more than 50 percent of imaging being conducted by other healthcare professionals. In addition, disruptive technologies and the decoupling of technical and professional activities will continue to erode traditional diagnostic imaging delivery structures.

“Imaging could become ubiquitous,” he observed.

Supply side fluctuations, such as radiologist or technologist shortages, can be mitigated by several factors. Among those he cited were increased productivity, working harder or longer, reduced or later retirement, turf competition, technology such as computer-assisted diagnosis (CAD) software, and the use of physician assistant (PA), nurse practitioner (NP), or radiology assistant (RA) extenders, Lexa said.

According to Lexa, patients are beginning to realign their relationship with radiology as customers of diagnostic imaging; he attributes this to the increasing role of the consumer in researching and selecting their avenues of care. As such, they have higher expectations on all service aspects of their imaging experience. And, they are increasingly in control of the disbursement of their healthcare dollars, Lexa said; citing data that approximately $550 billion to $600 billion of U.S. healthcare spending will be in consumer hands by 2011.

Despite the downbeat tone of the data he presented, Lexa believes that savvy radiological practices will be able to meet the challenges of the coming years.

“Don’t believe every prediction you hear,” he cautioned.

He advised the AHRA attendees to perform their own projections and to forecast their practice for at least 5 years into the future. When conducting this projection, a group needs to consider all the stakeholders that can affect its future, and then mapping its projections into likely vs. unlikely states.

“Use strategy and tactics to be ready for a tougher future,” Lexa advised.

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