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Radiologist: Commoditize Thyself

There is little in the health care world as amusing as watching radiologists work themselves into a froth over some real or perceived threat to their profession. Usually the villain is non-radiologists daring to encroach on radiologists’ turf. See, for example, Radiologists pull out the long knives as the radiology community attacks self-referral by non-radiologists. But the latest story (JACR article fires broadside against teleradiology firms) is about radiologists going after one another.

Gentlemen, we have met the enemy, and he is us! I didn’t pay $30 to access the article itself, but instead refer to an extensive summary on AuntMinnie.

David Levin, MD, and co-author Vijay Rao, MD, of Thomas Jefferson University in Philadelphia, make their case that teleradiology outsourcing contributes to the commoditization of radiology, lowered reimbursement, displacement from hospital and outpatient reading contracts, greater encroachment by other specialties, and lowered quality.

Here’s the problem:

Radiologists have been content to live off the fat of the land, working bankers’ hours and outsourcing inconvenient night and weekend duties to teleradiology firms rather than taking call themselves. Even when they’re around, radiologists in general don’t do a good job of serving the physicians who refer to them, staying in their dark rooms and not being proactive or even responsive. As radiology groups are finding, if they demonstrate they’re not crucial to the success of a hospital on nights and weekends, that also makes a pretty good argument for why they’re not necessary during weekdays either. Once hospitals understand the truth they can dispense with the local, intransigent radiology group entirely.

It may be news to radiologists that their actions are leading to commoditization, but it’s something I’ve been talking about for years. See Let the commoditization of medicine begin! for a taste of the argument.

Here’s what the authors propose as an antidote:

The authors recommend radiologists take a number of different steps. For starters, radiologists should cover their own practices 24/7, “just like in the old days before the easy-life mentality took over.”

“Don’t outsource night and weekend imaging to the teleradiology companies,” they wrote. “Without the business we give them voluntarily, they will cease to exist. This will not be easy, but it must be done if we hope to remain a respected and well-compensated specialty, rather than a commodity.”

The authors also recommend that radiologists not work for teleradiology firms, even on a part-time basis.

Those proposed responses are logical but I don’t see radiologists moving down that path en masse any time soon.

From a policy standpoint we should be pleased that this commoditization is taking place. If board certified radiologists credentialed by a high-quality hospital want to compete on price, I say bring it on!

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.

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grabofonekEmil KulwickismoothMary Murphy, M.D.David E. Williams of the Health Business Blog Recent comment authors
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grabofonek
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grabofonek

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Emil Kulwicki
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Is it fine to place part of this in my web site if perhaps I publish a reference point to this web-site?

smooth
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smooth

Physician services only make up 14-17% of Medicare expenses …telemedicine won’t solve any cost problems even if implemented perfectly…..but I think it is a slippery slope for all physicians to continue to corporatize and commodotize medicine. Also interpretations and protocols are not standardized inter institutionally..so I don’ t know if the above poster is well informed.

Mary Murphy, M.D.
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Mary Murphy, M.D.

I’m a radiologist. What I see in everyday medical practice is that PCP’s seldom lay hands on their patients. The actual History and Physical Exams are being performed by “physician extenders,” namely, Nurse Practitioners and Physician’s Assistants, and the radiology exam is very often used as a “surrogate Physical Exam.” Hence, the relationship of the PCP with his or her patients is morphing exponentially into a non-hands-on profession: The PCP reads the History and Physical notes (acquired and recorded by a physician extender), looks at the lab results, xray results, etc. and then logs in a diagnosis and treatment plan.… Read more »

Dr. David E. Marcinko MBA
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RBAR, Sorry for appearing cryptic; please allow this deeper exchange. All things being equal – ceteris paribus – my comments above are more correct than not. Of course, many docs have indeed been defeated in their ability to influence marketplace price [THINK: the SGR conundrum and the so-called “doctor-fix”] despite protestations to the contrary. Why you ask? In a word – “volume” – makes up for declining market power pricing to a certain extent. Mathematically, consider this simple equation: CPT® code payment [little market pricing power] X Volume [great control and market power] = Income Look, more volume is a… Read more »

David E. Williams of the Health Business Blog
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Brad, You asked me to comment on the WSJ blog about India not being a threat to US radiologists. To be clear, the teleradiology I’m referring to is done by US board certified radiologists, though some of the commenters don’t seem to realize it. Many of these teleradiologists are in the US, but some are based overseas. Often the teleradiology companies hire radiologists out of fellowship and set them up in a remote time zone, e.g., in Australia or Hawaii. That way they can work during their day when it’s night in the US. It’s a pretty attractive gig compared… Read more »

sandrar
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sandrar

I just finished reading “The Innovator’s Prescription” by Christiansen, et al, and this situation is analyzed in detail in the last chapter. Very interesting analysis, as is the entire book.

rbar
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rbar

No, hell MD, I just think that the current fee schedule is unfairly and counterproductively benefitting proceduralists/radiologists and surgeons. I am a specialist who does few procedures and I am happy with my income that is close to the income of a PCP (which is still in the upper 4%). I interact(ed) and work(ed) with many radiologists (and they tend to be smart since their specialty is competitive to get into); do I remind them that I think they earn too much? No.

MD as HELL
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MD as HELL

How about robotic surgery from India? You are in America under the robot knife, hopefully asleep under the care of the Indian anesthesilogist, and the surgeon is in India in a different hospital (or a hotel room) replacing your aortic valve (which was made in China by 12 year-olds) using a knock-off X-box 360 and pirated software.
Hope the internet doesn’t crash. Hope there is no weather to block the satellite.
Your records will be electronic, but in several languages, none of which you either read or speak.

MD as HELL
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MD as HELL

rbar has a problem with radiologists, apparently.

rbar
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rbar

At David M – I find your post cryptic. “It is ironic that the same domestic medical care [not just radiologists] that is the envy of the world has caused doctors to be defeated in their ability to influence the marketplace price by selling a quality, but nevertheless standardized service.” “envy of the world” – unsubstantiated, debatable statement at best. Yes, there are people from all over the world coming to Mayo, etc., but they come mostly from developing countries without strong (subspecialty and techological) medicine. And some european centers attract foreigners as well, occ. also americans. “defeated in their… Read more »

Photon
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Photon

Here’s another take on Dr. Levin’s article. I see it as nothing more than an attempt to make academic radiology departments relevant. The article explicitly argues for a closer tie between university radiology departments and local private practices. Whether this actually improves service or patient care is debatable, but it most certainly would improve the income of academic radiologists, a group well known for poor productivity and perpetual whining about income. The handwriting is on the wall for academic medicine in the era of Obamacare, and this is nothing more than a plea to shift the money flow from private… Read more »

nate
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nate

the patient is not choosing to send their test to india to be read so that decision then must be made by a US provider. Who ever in the US is deciding to send it would be legally liable. I’m certain US providers aren’t going to take on that liability not knowing who they are working with overseas.

Dr. David E. Marcinko MBA
Guest

The Enemy is Us
David – It is ironic that the same domestic medical care [not just radiologists] that is the envy of the world has caused doctors to be defeated in their ability to influence the marketplace price by selling a quality, but nevertheless standardized service.
Now, consider the economic effects of practice guidelines and standards, evidenced-based medicine [EBM] and comparative-medical effectiveness [CME], or the diagnostic testing epidemic in this light? Just remove the cognitive process from the delivery equation and – voila – commodity anyone?
Dr. David Edward Marcinko MBA
http://www.BusinessofMedicalPractice.com
[Editor-in-Chief]

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