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Five Things to Watch in 2013

By Jim Knaub

Here’s an abbreviated version of our “5 Things to Watch” article, which will be published in our January issue.

1. Changing the Relationship Between Radiologists and Patients
“Patients First” was this year’s conference theme and the topic of the address by President George S. Bisset, III, MD. But based on discussions I had with some attendees, radiologists hold different views of what it means to put patients first. Many agree that delivering a prompt, clear report to the referring physician and being available for consults forms the core. Beyond that, things are not so clear.

“I am as proud as I’ve ever been of our profession and all its wonderful clinical, [and] technical advances and diagnostic advances,” Bisset told his RSNA audience. “The two things we radiologists haven’t done very well as of late are anticipating and responding to the new patient-centered trends in healthcare. We’re behind and we need to catch up. Not only have we failed to give patients a sense of clinical control and engagement. We’ve gone a step further and left ourselves invisible to most of them. And this makes us vulnerable.”

Patient satisfaction remains something of a soft science, and radiologists often aren’t on the front line with patients. But it may prove very important in places with heavy competition for patients—and such places seem to be growing in number.

2. Radiologists and Competition
Increasing competition for patients also means greater competition among radiologists, including different forms of radiology practice. It seems radiologists are sorting out how they view that competition. Radiologists who embrace that idea have a better chance of continued success in that environment. Physician groups need to rethink how they will compete against these (and possibly other) imaging service models.

3. VNA 2.0
While the radiologist education programs at the meeting looked familiar, the exhibit hall seemed a lot more like the annual meeting of the Healthcare Information Management Systems Society. PACS and RIS simply have outgrown the radiology department and become a component of an organization’s larger IT system.

One interesting change is the evolution of the vendor-neutral archive (VNA). Just a few years ago, most of imaging discussed VNAs in terms of the DICOM-compliant system that would simplify PACS migration from one highly proprietary PACS to a more open storage archive that would ease future PACS migrations.

Vendors at this year’s meeting discussed VNAs as the software layer connecting the disparate digital information silos found in most hospitals so information can be delivered wherever it is needed in the organization. DICOM images, patient records, reports, non-DICOM images from dermatology and wound care, and digital fluorescein angiography images from ophthalmology are just some examples. This VNA layer serves to store information and connect it to the mushrooming numbers of data users—increasingly through EMRs. That’s what I loosely term “VNA 2.0.”

4. Acceptance of Healthcare Reform
The Supreme Court and voters have spoken since RSNA 2011, and the Affordable Care Act will move forward. My impression from RSNA was that, like the fifth stage of grief, the imaging industry seems to have accepted the coming of reform because it can’t really do otherwise. In 2013, imaging will begin to prepare for it.

While reimbursement reductions have changed radiology from the booming growth years of the early 2000s, many think that uncertainty over the future of healthcare reform had its own dampening effect on the industry (and the larger economy). A little more clarity might nudge things in a positive direction.

5. Appropriateness Criteria
Somehow, I think appropriateness criteria will have a significant future in the reforming world of radiology. Accountable care organizations (ACOs) and other models that move away from strict fee-for-service care will provide some push, as the widely held perception that some significant percentage of imaging is unnecessary will make it an inviting target. When ACOs receive a bundled payment for care, there will be incentive—and people tend to do what they are “incented” to do—to make sure an imaging exam is necessary and truly will add value to the care process. If I were a radiologist, I’d want radiologist-developed criteria guiding that decision rather than some mysterious radiology benefits manager.

— Jim Knaub is editor of Radiology Today.