While the future of the specialty itself remains bright, the forecast for the individuals practicing within it is far less certain. Nevertheless, physicians facing the financial cuts fueled by healthcare reform need to stand together to make sure their voices are heard.

Carmel

Hillman

Goldsmith

Muroff

That was the message conveyed by experts who discussed the current state of healthcare and trends that will impact radiology in coming years at RSNA 2011.

"Together we have quite a voice, and today, more than ever, we must use that voice," said American Medical Association (AMA) President Peter W. Carmel, who presented "Year Two of Health System Reform: Where are We Now?"

"We must stand up, we must speak out and we must fight for the changes that physicians and patients need," Dr. Carmel said.

Adapting to change is critical to surviving—and thriving—in such challenging times, said Bruce Hillman, M.D., a professor of radiology at the University of Virginia in Charlotessville, who presented "Saving Our Profession: How Radiologists Can Thrive in the Era of Health Care Reform."

As technology continues to evolve and the financial ground beneath the specialty shifts, radiologists must learn to respond to those changes or or face an uncertain future, Dr. Hillman said.

"Fundamental to the intellectual and financial success of radiology has been this amazing succession of new technology and expansion and networking of technologies that have made radiology so important in modern medicine," Dr. Hillman said. "Inevitably, if we are not successful innovators and we don't continue to adopt innovations, the 40-year reign of success for radiology is likely to go into decline."

Dr. Hillman discussed two specific examples of "disruptive technologies" for their potential to alter the industry. First are molecular technologies that target specific diseases and work with specific therapies for diagnosis. Second are information technologies—such as networking, communication and social media—that will facilitate physician-to-physician and physician-to-patient consultations.

"We need to change from what is working for us now—or at least some part of what is working for us—and invest in future disruptive technologies or radiologists could be disenfranchised," Dr. Hillman said. "We have to embrace these new technologies."

Declining Reimbursement is Among Financial Concerns

Financial compensation is also a growing concern for the specialty that has been targeted for payment cuts in successive federal bills that are bringing radiologists face-to-face with economic issues they haven't faced before, said presenter Lawrence Muroff, M.D., CEO and president of Imaging Consultants, Inc., in Tampa, Fla.

Dr. Muroff said five trends could alter what radiologists earn: declining reimbursement; Washington's love affair with family practice versus radiologists' image, or lack thereof, within the general public; more demands on hospital administrators for better medical imaging coverage; non-traditional competition for what used to be exclusive contracting with radiologists; and alternative payment systems including bundled payments and accountable care organizations."

Adapting to change is critical to thriving in such challenging economic times, according to experts (from left) Bruce Hillman, M.D., Jeff Goldsmith, Ph.D., and Lawrence Muroff, M.D., who presented, "Saving our Profession: How Radiologists Can Thrive in the Era of Health Care Reform," at RSNA 2011.

"Things are going to be far more difficult for radiologists than they had been for the last 10 years," Dr. Muroff said. "What we have now is not guaranteed. Some will thrive in the future, while many will be caught unprepared." Bundled payments are coming faster than many radiologists are expecting, he said, and radiologists should be prepared for them to be in place by 2015.

Nevertheless, Jeff Goldsmith, Ph.D., an independent healthcare consultant for Health Futures, Inc., in Charlottesville, Va., said he believes bundled payments are further off than Dr. Muroff estimates. Dr. Goldsmith said despite its problems, the fee-for-service payment structure will continue as the dominant payment system for quite a while, even as the federal government experiments with alternative systems.

"I believe, and this is a contrarian view, that the fee-for-service medicine is going to be with us for a while," Dr. Goldsmith said. "The simple reason is we simply do not have consensus for what would replace it."

AMA Reports Success Stories

Despite considerable challenges, Dr. Carmel discussed several instances where the AMA successfully fought for physicians, including radiologists.

The AMA joined with the American College of Radiology (ACR) to block $400 million in planned Medicare cuts to imaging services and worked with other groups to oppose the Medicare Payment Advisory Commission's recommendation to extend multiple procedure payment reduction (MPPR) to the professional component of imaging services. The MPPR proposed 50 percent cut was reduced to 25 percent, Dr. Carmel said.

"This shows that when physicians stand together, we can have a profound impact," said Dr. Carmel, a professor and chair of neurosurgery at the New Jersey Medical School, University of Medicine & Dentistry of New Jersey and co-director of the Neurological Institute of New Jersey.

As year two of the ACA plan unfolds, Dr. Carmel highlighted several of its positive results including the elimination of insurance coverage abuses, granting those individuals under the age of 26 coverage on their parents' healthcare policies, eliminating copayments for most preventive services, and the requirement that health insurance companies spend at least 80 percent of their premium dollars on healthcare or pay the difference to patients.

"This list indicates just how beneficial the Affordable Care Act is for millions of American patients," Dr. Carmel said. "The Affordable Care Act is an historic victory, but like so many victories, it is imperfect."

He pointed to the failure to repeal the Sustainable Growth Rate formula (SGR) as the foremost challenge.

Although a 27.4 percent Medicare pay cut was scheduled to take effect January 1, both houses of Congress on Dec. 23 approved a two-month payroll tax cut extension package that included a two-month doctor pay freeze. Physicians will continue to receive 2011 rates for Medicare services they provide through the end of February and lawmakers will need to agree on a longer-term solution in order to prevent the 27.4 percent cut from taking effect on March 1.

Dr. Carmel saved his harshest comments for the 12-member Congressional "supercommittee" charged with making federal deficit reductions. Although the AMA lobbied aggressively to repeal SGR, the supercommittee failed to reach an agreement.

"They had a golden opportunity to protect Medicare for future generations of seniors and they blew that chance," he said.

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