The fact that healthcare policy makers are shifting payment methods for medical services from a fee-for-service model to one based on care accountability could leave radiologists in an untenable position going forward, according to a viewpoint article published recently in the Journal of the American Medical Association.
Such a shift, write Steven E. Seltzer, M.D., and Thomas Lee, M.D., of Brigham and Women's Hospital in Boston, in the article "The Transformation of Diagnostic Radiology in the ACO Era," would turn diagnostic imaging from a profit center to a cost center and "give health systems an economic incentive to reduce further the use of diagnostic imaging." That in turn, they say, could encourage the use of potentially less effective measures of care.
At the same time, the authors write, many hospitals and physicians providing diagnostic imaging and image-guided interventional services live in a "mixed-payer environment"--in which some activities are paid on a fee-for-service basis and others become part of risk-based contracting.
The problem is that if radiologists shift too far in either direction it creates "a potentially serious moral and financial dilemma for radiologists and their institutions," Seltzer and Lee say. "Beyond potentially causing operational confusion for both the clinicians and the health system, contradictory financial incentives create the risk of distorting clinical decisions."
The only proper course for radiologists to take, they argue, "is to do the right thing for each patient," which means focusing on "improving value for patient segments defined by medical condition."
To do so, they add, radiologists must take on new roles with their institutions, including:
- Overseeing the content and implementation of clinical decision support systems that can be delivered electronically at the point of test or drug ordering
- Performing a range of consultation services related to the appropriate use of imaging
- Profiling the use of imaging tests at a clinician-based level to provide feedback and education to referring doctors about their imaging use patterns
- Leveraging lower-cost community sites that are part of integrated delivery systems
Radiologists also need to develop and promote image-guided interventions as alternatives to more costly and invasive treatments, something the authors say will improve patient care and reduce costs.
In an opinion piece published last summer in the Journal of the American College of Radiology, members of ACR's Radiology Integrated Care Network--formerly called the Accountable Care Organization Network--encouraged radiologists to proactively become involved in accountable care organizations.
"There are numerous practical lessons that can be learned and will be shared with other ACR members through RICN's activities," wrote RICN Chair David Rosman, M.D., and his colleagues. "One overwhelming initial conclusion is that radiologists must be engaged in the development and operation of these 'new' healthcare delivery models."
To learn more:
-see the article in JAMA