Radiologists: Sacrifice Income to Provide Value

CHICAGO - Radiologists must make themselves visible and valuable to their patients and their physician colleagues if they want to secure a bright future for the specialty, said David C. Levin, MD, professor emeritus at Thomas Jefferson University in Philadelphia during the Radiological Society of North America (RSNA) Annual Oration in Diagnostic Radiology.

Levin’s talk challenged radiologists to take a drastically different approach to their practice to stop the commoditization of the field in his talk, “Transitioning from Volume-Based to Value-Based Practice: A Meaningful Goal for All Radiologists or a Meaningless Platitude?” He noted that all physicians are being admonished to focus on value-based care over volume-based care, but that radiologists are truly at a crossroads that may determine the fate of the profession. Radiologists, he said, must either choose apathy and the status quo or “take meaningful action to transform what we do.”

He noted that many people in the medical industry view radiologists as overpaid, and uninterested in patients. He explained that some choices that the profession has made over the years have reinforced these views such as outsourcing night and weekend work and not engaging with patients or referring physicians.

“We have let ourselves become the invisible doctors,” he said.

To counter these perceptions, radiologists must begin acting more like consulting physicians, he said. He recommended that radiologists screen imaging requests for appropriateness and educate referring physicians about ACR’s Appropriateness Criteria and the Choosing Wisely campaign, which was launched by the American Board of Internal Medicine (ABIM) Foundation to identify medical tests and procedures that are often not necessary. The ACR was one of the first groups to partner with ABIM on the project. But, Levin noted, 72 of the unnecessary procedures identified so far are imaging tests done by radiologists.

“That is a huge number and something we all really have to worry about,” Levin said. He said professional radiology organizations should do more to publicize the Appropriateness Criteria to other specialties and that radiologists must do everything they can to eliminate unnecessary imaging.

Radiologists must also take a more active role in supervising technologists. Levin suggested a daily morning huddle, frequent feedback from the radiologist, and that technologists be encouraged to call with questions throughout the day. He also urged radiologists to make themselves available to referring physicians. For example, by creating a “Consultant-of-the-Day” who is available to field calls and handle consultations.  Levin noted that it is particularly important for radiologists to build strong relationships with primary care physicians and their staff because they will play an influential role in Accountable Care Organizations.

Patients must also become central to the radiologist’s work. Levin said radiologists should take back responsibility for reminding patients about follow-up imaging exams. They should do rounds to speak with patients and get more history, and give patients their contact information to field questions.[[{"type":"media","view_mode":"media_crop","fid":"30438","attributes":{"alt":"David C. Levin, MD","class":"media-image media-image-right","id":"media_crop_6859679689564","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3194","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"David C. Levin, MD","typeof":"foaf:Image"}}]]

For example, he noted Rob Milman, MD, a radiologist in Austin, Texas provides lectures to primary care physicians, administrators, and the public about the downsides of overutilization of imaging, the value of imaging, and appropriateness criteria. Levin said he’d like to see more radiologists do this kind of outreach.

Levin acknowledged that some radiologists may balk at taking time for unreimbursed tasks. But he said taking a small pay cut may be necessary to secure the future of the profession. He also noted that other specialties, such as primary care, spend much of their day on unreimbursed work.

“That’s what real doctors do,” he said. “They take care of their patients, even if they don’t get paid.”

Levin also recommended that practices “take back the night,” and stop outsourcing night and weekend work. He argued that outsourcing commoditizes care and gives referring physicians the impression that anyone can do the work. He also said he suspects that telemedicine firms will read an image for $25–$35, compared to the $75 CMS pays a radiologist, has likely contributed to declining reimbursement rates.

It will also be necessary for radiologists to demonstrate the quality of their work. Levin suggested that each practice identify and track 10–20 quality measures. He noted that some practices are already doing this with electronic dashboards.        

To help meet these new demands for work, Levin urged practices to hire young radiologists who can take on some interpretation tasks and free up time for non-interpretive tasks.

Ultimately, he said, radiologists must make some sacrifices now to ensure a better future for the field.

“Are radiologists going to be willing to sacrifice a small amount of income and personal convenience to provide real value and save the specialty from commoditization and disruption?” he asked.