Radiology Roundup: Insights on Emerging Trends


Radiologist Pointing to X-Ray of Hip Joint Radiology has proven to be resilient as it adapts to new technologies, payment models and other trends changing the profession. Staying in front of these trends is essential for leaders, as they help the profession position itself for the future.

In this roundup, a range of insights, opinions and perspectives are shared on existing and emerging trends. Two separate surveys look at patient interactions with radiologists from the patient’s perspective and the radiologist’s. Each confirms that patient consults are valuable, and both identify barriers such as physician proximity to workload volume.

You also will find an article examining the pros and cons for becoming a virtual group to participate in Medicare’s Merit-Based Incentive Payment System (MIPS). Another looks at the digitization of pathology and the benefits and challenges this presents for radiology.

1. Making Time for Patients: Positive Impact of Direct Patient Reporting

The radiology profession is working hard to demonstrate value amid the growing adoption of artificial intelligence. It’s well worth the effort, according to a small study conducted at Emory University Hospital in Atlanta, where 27 patients were surveyed before and after a radiology consultation.

Researchers reported 96% of participants found a face-to-face consultation with a radiologist helpful and 93% expressed interest in reviewing future studies with a radiologist. Maybe most significant was that 93% had an improved understanding of imaging findings and follow-up recommendations after meeting with the radiologist.

“Direct patient reporting of imaging results by a radiologist is feasible, even in a high-volume outpatient head and neck clinic, because it typically requires only 10 minutes or less,” the authors said. “With our reading room embedded in the clinic, physical barriers to direct reporting are improved, and the referring clinician and radiologist can efficiently develop management plans.”

2. Are Virtual Groups an Option for Radiologists Reporting MIPS?

Small practices or solo clinicians may want to form a virtual group to participate in Medicare’s Merit-Based Incentive Payment System (MIPS). While enrollment for 2018 ends December 31, there’s a full calendar year ahead to consider the pros and cons of this choice for 2019.

According to a recent column, forming a virtual group can be attractive. Pros include shared responsibility and shared risk, as well as access to performance improvement resources that might not otherwise be available.

There are a number of cons, however. Among several discussed is the potential negative impact that group scores can have on members. If a partner doesn’t fully engage, that member can lower the overall score, which impacts payment for every member. In another example, if radiology practice is exempt from the advancing care information (ACI) performance category because it is hospital-based or non patient-facing, and it joins with a practice that is not exempt from ACI, the practice will also absorb the ACI score from the other practice as part of the overall virtual group MIPS score. This could be positive or negative depending on the ACI score. However, it means that each member has even less control over this portion of the MIPS score, which will affect future payments.

In short, there needs to be clear oversight, trust, and commitment among the virtual group’s members for it to be successful.

3. Radiologists report why they can’t spend more face time with patients

Radiologists want to get out of the reading room to spend time with patients, but there is a major barrier to accomplishing this. An unrelenting workload fueled by volume-based reimbursement leaves them little opportunity to consult with patients.

That is the main takeaway from a survey of 5,999 RSNA members, recently reported in Radiology. The survey was intended to assess RSNA members’ attitudes and experiences concerning patient-centered radiology.

The majority, 73%, reported that time or workload frequently prevented them from communicating directly with patients. Some 74% reported that a personal sense of satisfaction was likely to motivate them to communicate more directly with patients, but many commented that changes to reimbursement and compensation would help them communicate with patients more directly.

The study authors discussed their findings at the RSNA annual meeting. Other insights included the need to talk to patients directly, especially if there have been conflicting reads of the image or discovering something was missed.

“Instead of the ED doctors telling the patient that the radiologist missed something, we instead tell the patient multiple people looked at the image,” said co-author  co-author Dr. Max Wintermark. “That gives us a little more control over the message, to make the patient feel better.”

4. Could Providers’ Early Lack of Interest in the Value Modifier Program Set a Precedent for MIPS?

An opinion piece on Medicare’s pay-for-performance programs speculates that smaller clinician practices could be forced out of business unless they are equipped with the technology and workforce infrastructure needed to report on quality metrics to avoid rising payment penalties.

The author responds to research in Health Affairs, which suggests that the large number of practices being penalized in one quality performance program suggests trouble ahead as others are implemented. Data available on the Physician Value-Based Payment Modifier (VM) program, shows that 29% of participants in the VM quality reporting program failed to report performance data and received a 1% penalty in their Medicare payments as a result in 2015.

The size of these penalties grows over time, with the Merit-Based Incentive Payment System (MIPS), which started in 2017, seeing penalties climb to 9% by 2020. As the movement to value-based payment models and quality metrics grows, the author fears that small or solo practices may become a thing of the past.

5. A Path to Follow?

The FDA has approved use of the first digital pathology solution, as digital imaging makes inroads into pathology. This opens the door for pathology and radiology to bring together data essential for diagnoses and treatment plans.

This article taps expert opinions on the benefits and challenges of such a convergence. Ideas include the potential for the two disciples to merge and create a new diagnostician with deep knowledge of disease processes to deliver insights and expertise in diagnoses and treatment pathways.

Benefits include standardized reporting accessible from a single portal. Challenges range from the large amount of storage required for pathology images to cultural resistance to workflow changes and more.

Radiology is facing change at an unprecedented rate. It is continually evolving as technology, value-based reimbursement, and other trends change the landscape. It’s important to hear from stakeholders in the profession to learn from their opinions and perspectives. To stay in front of industry trends and the latest news, subscribe to the Medical Imaging Talk blog.

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