When we first saw the numbers contributed to our “Turn-of-the-Century Census,” we were overwhelmed. How will we make sense of these numbers from four different sources, I wondered. How can they be incorporated into a cogent whole? Will readers understand that these unrelated statistics are not meant as a truth to be held closely, but rather a view from the bridge? I would heartily agree with the old adage that numbers do not lie. But the people who toss them around do. As such, numbers have been pressed into service for all manner of iniquity, and quite frankly, we did not particularly want to be a party to that endeavor. However, after publishing a fine macroeconomic look at radiology’s overall economic climate by Johnson B. Lightfoote, MD, in the November/December 2000 issue of Decisions in Axis Imaging News, we thought it would be interesting and instructive to zoom in, if you will, for a view of the profession in close-up. I hope you will accept the invitation and spend some time reviewing Peter Pesavento’s article, “A Turn-of-the-Century Census,” beginning on page 22.
Many interesting trends were identified. The number of radiologists is increasing at a rate of about 2% per annum, and radiology utilization is increasing at about 10%. Furthermore, the modalities driving the increase are MRI/MRA, CT, and nuclear cardiology, not the least time-consuming of all radiological studies. The cost of radiology for payors is also increasing, but a small percentage of studies (primarily those mentioned above) is driving the lion’s share of the growth. Utilization rates among the older Medicare population are greater than those of the younger population in a commercial insurance plan. Most of this I suspect readers could have surmised. Seeing the numbers on paper, coupled with the utilization projections for Medicare-aged Baby Boomers, however, is downright sobering.
Another interesting exercise involves thinking about the implications of one set of numbers in the context of another set of numbers. For instance, one set of utilization numbers demonstrated bone mineral densitometry (BMD) as experiencing the greatest growth of all modality imaging from 1998 to 1999 (52%) within the combined members of nine health plans. Yet BMD accounted for just 1.8% of total spending with a utilization per member rate of 173 per 1,000 among Medicare-aged females. When viewed in the context of the projections performed on an unrelated set of data that illustrated the impact of the Baby Boomers as they moved into and through the Medicare years of 65 and older, it appears that BMD has yet to reach its period of maximum utilization. Surely the Me Generation will keep closer tabs on its bone mineral density readings than previous generations, so when seen in context of the social characteristics of the Baby Boom population, future projections for BMD utilization may well be overly modest.
Without the data from our contributors, this article would not have been possible. And so I wish to thank editorial advisory board members Cherrill Farnsworth at HealthHelp, Houston, and John Donahue at National Imaging Associates, Hackensack, NJ for the utilization data drawn from a combined data pool of more than 4.5 million member participants; Jonathan Sunshine, PhD, of the American College of Radiology for sharing statistics that illuminated the number of radiologists and associated trends in specialization; and Mitchell Goldburgh of IMV for helping identify trends in technology purchasing.
As we reviewed the contributions, many further questions began to formulate, and foremost was this: How are radiologists managing the increase in volume? Increased efficiency? Longer work weeks? Is information technology playing a role? Those questions and others that occurred made us think that perhaps we should try this again, and include a readership survey. So I ask you this: what kind of data would be most interesting to you? What questions would you like answered?
Please send your thoughts on that subject to [email protected] .