From all four corners, the bullets are flying, and in the final analysis, radiology is completely and unaccountably alone in its quest to preserve the future of the profession.

Physicians of all stripes, suffering from income erosion, are buying imaging technology in droves, hoping to foster ancillary income. Law and policy makers, seeking to corral Medicare costs, have designated imaging, the fastest-growing component of the Medicare program, as low-hanging fruit (see Imaging in the Crosshairs). Wielding a double-edged sword, CMS has put forth several strategies aimed at curbing overutilization and cutting imaging reimbursement in its proposed rule, still under deliberation at this writing. While the atmosphere is fraught with danger, radiology may never again find itself at the confluence of issues with such socio-economic import.

At the heart of it all is soaring costs. Sooner or later, Congress is going to have to get serious about controlling Medicare program costs. CMS and other payors have been collecting evidence that supports the idea that self-referrers overutilize imaging. But simply keeping technology out of the hands of those with the incentive to overutilize is not enough. Radiology must embrace the concept of imaging appropriateness and develop the tools that will ensure that imaging provides a return on the investment.

Dovetailing with the issue of imaging appropriateness is the issue of the appropriateness of the imager: just who is qualified to read imaging studies? Quality is emerging as a major issue in health care, and radiology needs to be able to both measure and authenticate itself in the quality arena. That is why the debut of the new web-based eRADPEERTM is well timed. Introduced by the American College of Radiology (ACR), it fulfills the dual purpose of providing peer review while also collecting data in a central repository that the ACR can use to start developing quality thresholds. The program has been engineered to integrate with radiologist workflow and kicks in only when reviewing priors, when the radiologist assigns a score of 1 to 4 to the original reader. Scores are submitted to the ACR; monthly reports are sent to the chair, the practice president, or other designated administrator. 113 practices representing 2,000 physicians already participate.

Explains Kenneth W. Chin, MD, chair, ACR RADPEER Committee, and member of the MEMRAD group in Los Angeles: “On CT, if we say that the rate of occurrence of a 3 or 4 score should be less than 5%, then that will be the threshold we will be asking people to meet. It may not be that low, it may be higher: the whole idea is to get honest information.”

Radiology needs to play this out to win for all of the right reasons: to preserve the solvency of our health care system, to improve patient safety, and to preserve the future of the profession. This is the season of miracles, so feel free to draw a card from the deck of the White Sox and play a little…hardball. In Hardball, Are You Playing to Play or Playing to Win, authors Stalk and Lachenauer outlines the following principles: focus relentlessly on competitive advantage; strive to convert competitor’s advantage into disadvantage; employ indirect attack; exploit your employees’ will to win; and draw a bright line in the caution zone.

Radiology, play ball!

Cheryl Proval