7. Spread the word about appropriateness: Radiology hasn’t done a good job at educating primary care providers, residents, and medical students about the American College of Radiology’s Appropriateness Criteria. Publish papers in clinical journals other than those dedicated to radiology.
8. Reach out to primaries: Under health care reform, primary care physicians will play a bigger role in patient care. Improved relationships between these physicians and radiologists could enhance diagnostic abilities and decrease the need for engaging sub-specialists, she said.
9. Fix the image: Not the study you’re reading — the image radiology has in the medical profession. According to Rao, radiologists should focus less on money and lifestyle. It’s no secret that radiologists are well-compensated, and much of the hospital often believes you’re not working hard. Demonstrate the added value you bring and shift away from lifestyle concerns.
10. Make it about quality: Focus like a laser beam on improving your quality metrics and develop a way, such as a dashboard or scorecards, to track them. Then, share the result with the hospital. It’s not possible to monitor and improve the more than 300 quality metrics directly associated with radiology, so pick five or 10, Rao said, and work on those. Patient safety, contrast reactions, universal protocols, and outcomes measurements for procedures could be good places to start.
11. Promote research: Radiology needs more research from private practice. Either conduct your own or support someone else’s, she said. Running studies could help change the industry’s reputation for being a commodity.
12. Be a service line: Many hospitals are now creating and publicizing service lines, and most concentrate on five areas: cancer, cardiology, gastroenterology, orthopedics and neurology. Radiology loses out because its providers work horizontally across all disciplines. Suggest hospital administrators consider radiology to be a service line in your facility, Rao said. After all, diagnostic imaging’s contribution margin to outpatient services is 37 percent.
13. Fight radiation hysteria: Yes, undergoing a diagnostic scan exposes a patient to radiation. But, said David Levin, MD, a radiologist at Thomas Jefferson University Hospital, radiologists must work hard to allay the public’s fears by discussing and publicizing efforts to reduce dose, recording dose parameters, and emphasizing patient safety efforts. Educate your patients that a single CT scan will only increase their existing 25 percent lifetime chance of developing cancer by a miniscule amount.
14. Be a consulting physician: To counteract the existing commodity reputation, Levin recommended you act more like consulting physicians. Screen for the appropriateness of imaging tests, work with referring physicians to cancel or change inappropriate scan orders, and be willing to discuss results with the referring doctor. Consider having a consultant of the day where each radiologist sits in an office one day a week and answers questions.
15. Make room for new jobs: It might mean sacrificing some individual income, but you must make room for younger radiologists to come on board. Unless medical students know that they’ll be able to find jobs after they finish training, fewer will select a radiology residency, Levin said. In fact, according to data from the Association of American Medical Colleges, the number of unfilled radiology residency spots jumped by 53 from 2011 to 2012, leaving 86 positions open nationwide. New physicians could help with consultative services, and they could help you rebuild a night or emergency service.
16. Be proactive about dropping reimbursement: Cuts to Medicare payments aren’t going away, but you can prepare. Many of you are already becoming hospital employees, and the trend seems to only be increasing, Levin said. He suggested free-standing practices seriously consider lowering their charges and encourage nearby hospitals to do so, as well. In an era where payers are steering patients to low-cost providers, reducing charges can prevent a loss of business.
17. Bolster the real doctor reputation: Many health care professionals don’t think of radiologists as real doctors, especially now that almost every specialty is involved in some type of minimally-invasive, image-guided procedure. To counteract this, Levin said, build up your interventional radiology services. Negotiate for space for an IR clinic, including recovery areas, care coordinators, and adequate nursing and physician assistant staffing. And then demonstrate how the clinic will help reduce costs and get patients out of the hospital faster.
18. Lobby against self-referral: Although the federal government doesn’t appear interested in policing self-referrals, Levin said, radiologists could find advocates at the state level and with payers. Work with state legislators to craft bills to crack down on non-radiology providers who self-refer. Payers, such as Independence Blue Cross in Philadelphia, can also adopt policies that deny payment for imaging services not provided in a full-modality imaging center.
19. Talk to the press: Get involved with the news media. You have a responsibility to educate reporters about radiology risks, what radiologists do, the problems with self-referral, and all quality and safety initiatives.
20. Demonstrate added value: Show your hospitals and colleagues that you bring more added value to the facility than do teleradiologists. Highlight what facilities will lose if they farm radiology services out to a teleradiology company.
Even with these threats and the many steps radiologists should take to overcome the problems, Levin said there’s no indication that radiology will be going away.
“The population is aging, and older patients use imaging three to four times more than younger patients. There’s also an increase in the number of insured patients under the Affordable Care Act, and new technologies will continue to be developed as years go on,” he said. “If we continue to put the patients’ interest first, behave like consulting physicians, take back the night, and do everything possible to eliminate unnecessary imaging, radiology will continue to be a well-compensated, exciting profession.”