AJR: Commoditizationis the end in sight?

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Radiologists might have brought the commoditization of radiology upon themselves, but the competition that has fueled the phenomenon could also be the approach that decapitates it. Competition could reverse the trend toward commoditization and buttress quality, argued a Masters of Radiology panel in the April issue of the American Journal of Roentgenology.

With the growth of teleradiology and nighthawk services and the concomitant invisibility of radiologists to patients and many ordering physicians, radiologists have become increasingly worried that their specialty is becoming a commodity. A panel of six radiologists examined the issue through a sober lens, to define the commonly tossed around term ‘commoditization’ and to consider its causes, implications and potentially steerable directions. The teleconference and article were moderated by Howard P. Forman, MD, MBA, of Yale School of Medicine in New Haven, Conn., and Marcia C. Javitt, MD, from Walter Reed Army Medical Center in Washington, DC.

“I would define commoditization (in the sense that most radiologists use it) as competition that occurs based primarily on cost and service, with little regard for clinical quality,” said David B. Larson from Cincinnati Children’s Hospital in Ohio. Commoditization is seen by radiologists as sprouting from competition, a trend toward radiologists serving only to provide reports and cookie cutter interpretations undifferentiated from those of other radiologists.

The term commoditization is often used pejoratively. Amid all this pessimism, though, Forman went against the grain in his evaluation of imminent doom: “Being a commodity is not necessarily bad. A commodity in and of itself is not without value; it’s just undifferentiated.”

“It is becoming increasingly clear that competition in radiology is here to stay,” Larson added. Rather than lamenting this point as a “downfall,” the authors framed it as an opportunity. “We are in danger of becoming a commodity, and competition is not our downfall, it’s our savior,” argued Alan D. Kaye, MD, from Advanced Radiology Consultants at Bridgeport Hospital in Westport, Conn.
The panel considered competition as arising from three sources: cost, service and quality. Commoditization, in the panel’s view, translated to competition among radiologists based on cost and services; the antidote needs to be competition based on quality—radiology’s raison d’etre.
Quality is both ill-defined and difficult to measure, the panel conceded. “I think that tends to be one of our core problems right now—indeterminate quality and a lack of agreed-on discrete quality metrics. We’re hard-pressed to explain to society, consumers and referring physicians the true value of radiology processes at either the subspecialty or the general level,” contended Alexander Norbash, MD, radiologist at Boston University Medical Center.

To combat the threat of commoditization, radiologists need to begin by establishing a consensus on quality metrics and redesigning the practice of radiology to be more efficient and profitable, the panel agreed. Norbash considered IT to be an important component of the system, “by adding value and helping us use more evidence-based practices.”

Kaye blamed radiologists for allowing commoditization to seep into the specialty, but considered them to be the agents to bring about its defeat. Aside from quality, the panel discussed several of Wal-Mart’s practices as models, in that the company built an infrastructure of low-cost products directed at providing customers what they want and ensconcing loyalty.

By playing a more active role in the caregiving process and taking greater heed of customers’ (ordering physicians' and patients') preferences for quality, service and cost, radiologists can push competition in the direction of quality and trump commodity. “In fact,” Larson argued, “if it is structured correctly, a competitive marketplace can, and often does, create a ‘race to the top.’”

“If we took a lesson from Wal-Mart and decided to use our incumbency to enhance customer loyalty by giving them what they want at a reasonable cost, I think we can turn around the threat of commoditization.” With efficiency as a base, radiologists must reach consensus on metrics and standards for quality, in order to distinguish themselves and compete to provide the highest quality care, the authors summed.