RSNA: Changes in practice & policy critical to rads survival

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CHICAGO—As radiology struggles to prove its worth amidst mounting cuts for reimbursements and questionable study orders, innovation and judiciousness in exam orders are crucial to save the profession, according to a lecture presented Nov. 28 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

While radiology has flourished in the last three decades due to tremendous technological innovation and therapeutic progressions, two rounds of 25 percent cuts to imaging reimbursements from the Deficit Reduction Act of 2005 and the Patient Protection and Affordable Care Act of 2010, confounded with worries that up to one-third of radiology studies do not improve patient health, put radiology in serious jeopardy not only of slowed but of drastically reversed growth.

Several changes within radiology are essential to the preservation and reinvigorated thriving of the profession, argued Bruce J. Hillman, MD, scientific affairs director for the American College of Radiology's (ACR) Medical Advisory Panel, including:

• Innovation—Clinical radiology needs to transform itself into a combined diagnostic-therapeutic specialty, which will require shifts away from anatomical imaging towards cellular, functional and quantitative studies and treatments.
• Prediction and preemption—Radiology must strengthen its determination of risks for earlier treatment and improved patient outcomes. Doing so requires more personalized and participatory medicine between physicians and patients, including using genetic indicators for earlier treatment and risk determination.
• Discretion—Whether or not the oft-quoted one-third of imaging studies performed by radiologists are in fact unnecessary, radiologists need to reject some studies and moderate their reporting of unimportant ancillary findings.
• Consultation—Another important part of participatory medicine, radiologists should reassume their roles as consulting physicians and spend more time with patients as well as referring physicians.

Hillman emphasized the importance of assessing the value of radiology to society at large, particularly in relation to government cuts for physician reimbursements. In Hillman's view, the innovation that has kept radiology at the front line for diagnosis and increasingly treatment can progress to integrate these two approaches earlier and with greater success, but appropriate funding for healthcare is critical.