Health Reform is Reducing the Cost of Radiology: How do Radiologists Remain Competitive?

By Bill Bunker, Executive Vice President, SCI Solutions

While healthcare saw a rapid increase in spending on diagnostic imaging around the turn of the century, the trend dramatically slowed in recent years. Why the change? Over the past decade, government healthcare regulations have put a greater emphasis on cost effectiveness, including significant reimbursement cuts for radiology orders. Despite the radiology market taking a downturn, an increasing number of medical students continue to choose the field of radiology for the high earning potential and balanced lifestyle. This combination of factors means radiologists can no longer rest on their laurels; instead, they must stay ahead of their competition by distinguishing their services and cultivating relationships with fellow practices in their community.

Taking the ROAD Less Traveled?

Radiology, ophthalmology, anesthesiology, and dermatology (ROAD) make up a group of specialties widely perceived as being desirable due to the lifestyles they permit physicians. For instance, the salaries are typically higher for specialists than family medicine doctors, and radiologists are among the highest paid physicians. With a median annual income of approximately $380K, they earn more than twice a typical primary care provider’s salary. Furthermore, the hours tend to be more consistent and reasonable. Whereas an obstetrician may be called in the middle of the night regarding a delivery, radiologists are typically able to work more traditional hours on a regular basis. In a study by published in JAMA, 3.3% of senior medical students planned to pursue radiology (a “controllable” specialty) in 1996 and by 2002 that figure was up to 6.1%. In contrast, OB/GYN (an “uncontrollable” specialty) interest decreased from 7.5% to 6.0% over the same time frame. These lifestyle benefits can be incredibly tempting for medical students, especially considering the sky-high student debt and long hours incurred during medical school.

Shopping for MRIs: Commoditization of Radiology

While the benefits of ROAD specialties are attractive, is there enough demand to keep up with the increasing supply of radiologists? Not only has insurance spending on imaging decreased since 2003, there has been a decline in physician radiology orders as well. With the influx of radiologists in a declining market, the face of radiology continues to evolve with cost-saving measures such as:

  • Reimbursement cuts for services rendered
  • Pressure from insurance companies for patients to go to the least costly destinations
  • Popularity of teleradiology services, which has tripled in the last decade
  • Increasing reliance on radiology assistants and radiologist practitioner assistants instead of radiologists The first two points exacerbate the need to make cost-effective decisions, whereas the second two points reduce the demand for radiologists. While radiology is not a commodity, radiology services can feel a bit more tangible than other medical specialties.

How Radiologists Can Succeed Despite Pricing Pressure

Between the Deficit Reduction Act of 2005, Patient Protection and Affordable Care Act, dramatic changes in the way patients, insurance companies, and physicians interact have been underway. Heavy emphasis has been laid on accountability for providers and insurance companies. The ultimate goal being to maximize the patient experience while improving community health as a whole, all in the most cost-effective way possible. Radiology practices rely on their business through patient referrals from referring practices, which means establishing strong community relationships is critical for success but not the only factor. Other influential key points referring providers consider before selecting a radiology practice to send their patient may include:

  • Communication: How responsive is the radiology practice? How quickly will they schedule and see my patient?
  • Cost: Does the radiology practice accept my patient’s insurance? How do their prices compare to other radiology practices nearby?
  • Care Coordination: Does the radiology practice follow-up with my patient’s return report?
  • Easy to Work With: What are the expectations for completing insurance authorization work?

To the last point, an increasing number of radiology practices have taken on their own referral insurance authorization work, which traditionally was completed by the referring provider. Why is this good for business? Many radiology practices find the authorization work they receive from the referring practice is incomplete or for the wrong CPT code, leading them to correct and do the authorization work anyways. By offering to take on this work on up front, it saves everybody time and may reduce write-offs down the road.

Efficient Referral Management Can Increase Referral Capture Rates

Studies show that half of all referrals do not turn into visits. That means patients are not receiving the care they need, and radiology practices are not capturing all the business intended for them. Why is it so hard to schedule referred patients? Referrals are a ticking time bomb – the faster radiology practices contact their patient to schedule an appointment, the more likely it will happen. However, obtaining insurance authorizations prior to the visit often hold up the process for days, even weeks at a time. Authorizations are admittedly a pain to complete – staff pulling information from multiple information silos such as EMRs and fax machines, spending long hold times with payers, etc.

Clarity Health addresses these problems by offering a web-based platform to manage referrals in one, streamlined work list. Even better, Clarity’s service team takes insurance authorization work off the practice’s plate and completes it in just hours instead of days. This approach enables radiology practices to capture more of the referrals they are already receiving and turn them into scheduled visits. Beyond better referral capture rates, Clarity’s two-way communication gives referring providers real-time patient status updates and return reports, helping to close the care coordination loop. The landscape of radiology may be changing, but there are proactive steps radiologists can take to stay ahead and strengthen their relationship with their community to ultimately provide better care for their patients.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s