The Sky is Falling

Dear Editor:

In your Viewpoint comments (December 2003) you state that there is no question that payors, including the federal government, will be looking at imaging with “greater scrutiny as imaging costs rise….And radiology must heed these concerns.”

Indeed, yet other forces are at work that may be out of our control. In my neighborhood, we have had a family practitioner approached by a major vendor to purchase a 3T MR imaging device for his office. A two-person neurology practice in our area is currently entertaining three proposals, one from a family practitioner, one from an entrepreneur, and one from a nationally known entity, to partner in high-field MR imaging. We “caught” an infectious disease specialist on staff at a local hospital in our area at the RSNA purchasing a low-field open MRI machine, and another family practitioner in our area cannot make up his mind between a 0.7T and 1.5T MR platform. An otolaryngologist in our neighborhood is entertaining purchasing a CT scanner to do his limited sinus studies, and the local orthopedics group is updating their scanner as we speak.

Somehow, I suspect that radiology groups will overcome their paradigm paralysis, realizing that hospital-based practice models and radiologist-owned freestanding imaging centers may become but one of a number of practice venues radiologists will encounter going forward. Clearly, clinician-owned high technology imaging devices will not lend themselves to more favorable utilization. Can you imagine the local family practitioner passing up the opportunity of performing an MRI of the head on his patients with headache? Vendors, and their newly created entrepreneurial business units, which target primary care and referring physician practices as potential consumers of high technology imaging hardware, are waving their pro formas at salivating primary care physicians who see nothing but decreasing revenues and rising practice costs.

The result, I fear, will be a shotgun approach to controlling the rise of imaging costs by the third-party payors, especially the federal government. Solutions will not be applied selectively depending on who is rendering the service. In the end all will suffer. We certainly live in interesting times.

Allan M. Haggar, MD
LaGrange, Ill