Radiologists Need to Take Action in Transition to Value-Based Practice

Radiologists must be willing to take meaningful action to transform and improve the way they practice in order to make a successful transition from volume-based to value-based practice, according to David C. Levin, M.D., the presenter of the RSNA 2014 Annual Oration in Diagnostic Radiology.

By Paul LaTour

David C. Levin, M.D.

"We need to become better doctors—real doctors, if you will—who provide real value to our patients, our referring doctors and our hospitals," said Dr. Levin, professor and chairman emeritus of the Department of Radiology at Jefferson Medical College and Thomas Jefferson University Hospital in Philadelphia. "We've let ourselves become the invisible doctors and that is something none of us are happy about."

Radiologists are their own worst enemies by allowing the perception to grow that radiology is a commodity rather than a true specialty, Dr. Levin said. That perception, he added, has led to threats to the profession from inside and outside healthcare, including declining reimbursements and the idea that much imaging is inappropriate or unnecessary. Other threats include an increased emphasis on utilization management and termination of groups by hospitals that then turn to teleradiology companies.

Fortunately, Dr. Levin continued, radiologists have plenty of opportunities to create a new perception—that they add real value to the patient-care process. Radiologists can act more like true consulting physicians by supervising and monitoring every advanced imaging exam, bolstering their input with guidelines such as American College of Radiology Appropriateness Criteria. Being a true consulting physician also means giving patients access to results, either verbally or via an electronic portal, he said.

Radiologists Must Be Available to Patients, Referring Physicians

Dr. Levin also advocated for radiologists being more available to their patients and referring physicians. The first step, he said, is to stop outsourcing to teleradiology companies, which Dr. Levin said devalues the work of radiologists. "By outsourcing nights and weekends to teleradiology groups, we are shooting ourselves in the foot," he said.

Developing and tracking internal quality metrics—and then publicizing them—also adds value, Dr. Levin said. To prove value, you have to prove quality, he said. "You can't just beat your breast and proclaim to the rest of the world that you provide high-quality imaging," he said. "Everybody says that. So those words don't mean a damn thing."

Finally, radiologists must build closer ties with not only primary care physicians, but with nurse practitioners, physician assistants and others who are going to become more influential under Accountable Care Organizations, bundled payments and capitation.

Dr. Levin concluded with a prediction: if radiology groups follow these steps, in five years the specialty will no longer be viewed as a commodity—referring doctors will see radiologists as contributing value and look for guidance on imaging and patients will come to respect radiologists as "real doctors."

"This could be our future—just think of that," he said. "But it's only going to happen if we change the way we do business. It's not going to happen if we just sit back and opt for the status quo."

Oration Dedicated to Wagner

This year's Annual Oration in Diagnostic Radiology was dedicated to the memory of Henry N. Wagner, Jr., M.D., a towering figure in nuclear medicine for over half a century. Dr. Wagner published more than 800 articles and many books and was a member of the Institute of Medicine. His scientific contributions included the development of lung scanning to diagnose pulmonary emboli and pioneering studies to image neuroreceptors in the living human brain—the first brain imaged was his.

Dr. Wagner was also a hugely influential educator. More than 500 physicians and scientists were educated through his programs in both medicine and radiation science at Johns Hopkins University School of Medicine, including David C. Levin, M.D., presenter of this year's oration.

"He was truly a superb educator and a superb scientist, so it's a special privilege for me to be able to give this lecture in his memory," Dr. Levin said.

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