Play Well in the Sandbox, or Else
Change is coursing through the healthcare pipeline. In fact, the very nature of change seems to be evolving. In the last two decades, technological developments monopolized the radiology spotlight. Profits hinged on a practice's ability to adopt and adapt to digital infrastructure. Other business essentials, such as building relationships with referring physicians and educating clinicians about imaging indications, were considered as part of the equation, but they often took a back seat to the holy grail of technical optimization.

This pursuit of optimal technical infrastructure and maximum throughput dovetailed quite nicely with a fee-for-service reimbursement model that rewarded procedures.

The passage of the HITECH Act followed by the Patient Protection and Affordable Care Act ushered in a new model. Today, our vocabulary comprises terms like accountable care organization and comparative effectiveness. Experts are still ferreting out the meaning of some new requirements. Nonetheless, Peter Zwerner, MD, co-director of the Medical University of South Carolina Chest Pain Center in Charleston, suggests, "These are all buzzwords for 'play well in the sandbox or else.' We need to figure this out, or it will get legislated."

It means, as we explore in our cover story, that radiologists need to forge a new collaborative practice model with cardiologists. It's bitter medicine for some physicians, who cling to ancient grudges about lost procedure volume and want to maintain a solo stronghold on imaging.

As unlikely and unpalatable as the collaborative model may seem to some, it isn't the only paradigm shift on the horizon. Comparative effectiveness, the subject of our cardiac imaging feature, will force physicians to factor clinical effectiveness into the ordering process. (In other words, the shotgun, multi-study approach to imaging will be disincentivized.)

The changes are linked. In the March issue of the Journal of the American College of Radiology, Jonathan Breslau, MD, from Radiological Associates of Sacramento Medical Group in Sacramento, Calif., and Frank J. Lexa, MD, MBA, from the Wharton School at the University of Pennsylvania in Wynnewood, wrote, "In an accountable care environment, radiologists can and must help emergency physicians, hospitalists and primary care providers reduce utilization and move away from over-ordering imaging tests." That is, radiologists need to help clinicians determine the right test the first time and focus on wise utilization of the imaging modalities at their disposal.

Radiology will survive and thrive by changing with the system and helping inform how the system changes. In the ideal scenario, healthcare providers optimize imaging infrastructure by leveraging the full breadth of radiologists' expertise, going beyond image interpretation and emphasizing experience and informed decision making. It's a change of focus, but one that is well within radiologists' reach.

As always, we at Health Imaging & IT are eager to hear from our readers about how they are changing, adapting and building their practices. Stay in touch.