CHICAGO — It’s a common topic of conversation in radiology today: The profession is under attack from several fronts. This lament is most certainly true, but there are several ways to conquer these problems, industry experts said at this year’s RSNA annual meeting.

But before you know how to fix the situation, said Jonathan Berlin, MD, associate professor of radiology at Northwestern University Feinburg School of Medicine, you have to understand the forces working against you.

The Threats

1. Declining reimbursement: This issue is no surprise. Since 2006, Medicare reimbursement as slowly dwindled. Until recently, the drops only affected the technical component, but this year, CMS retained the multiple procedure payment reduction (MPPR) to the professional component. It will eliminate 25 percent of the payment you receive for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice, during the same session, on the same day. Add bundled payments, combined codes, and the new accountable care organization model, Berlin said, and CMS is whittling away your reimbursement.

2. Bad job market: Ask any radiology resident, and he or she will tell you there are simply no jobs available in the field. Confusion around reimbursement and the radiologist’s role in health care has prompted many practices and departments to freeze any hiring efforts. Less job opportunity is already equating to fewer medical students pursuing radiology as a specialty, and existing resident morale is at an all-time low, he said.

3. Commoditization: In recent years, rather than focus on all the work associated with diagnostic imaging — the pre-, intra-, and post-service — radiology has placed the greatest emphasis in image interpretation. And hospitals and referring physicians have followed suit, giving the profession the reputation for being a commodity rather than an integral specialty. Many facilities now outsource their image reading to the lowest bidder, and many insurance companies now steer patients to facilities that offer services at the lowest cost.

4. Teleradiology companies: Although shifting night reads initially seemed like a good idea, corporate teleradiology companies are now expanding beyond nighthawk work. Many are now stealing hospital contracts away from local radiology practices, promising to offer high-quality care at reduced cost.

5. Medically-inappropriate imaging: CMS and other health care agencies now estimate that 35 percent of all imaging studies conducted are unnecessary and don’t contribute to diagnosis. A major reason for this is self-referral, non-radiologists who purchase scanning equipment in order to perform studies without sending a patient to an outside radiology practice. In many cases, the physicians are practicing defensive medicine, but they lack the proper skills to correctly interpret studies.

While these challenges are significant, said Vijay Rao, MD, chair of radiology at Jefferson Medical College at Thomas Jefferson University, there are many strategies at your disposal to reverse these trends.

1. “Take back the night”: Don’t outsource to teleradiology companies, and don’t work for them. Instead, find a way to bring night reads back into your practice.

2. Consolidate: If your practice is too small to handle night reads alone, consider merging with a larger group or multiple groups. This move can also increase your ability to offer subspecialty services. Mega-groups, she said, will likely be very common in the future of radiology.

3. Affiliate: Free-standing practices are vulnerable under the new models of care. Contract with a hospital or a larger multi-specialty group. You could even consider becoming a hospital employee. Any of these decisions would help protect your revenue.

4. Build bridges: Work on your relationships with hospital administration and become more active in hospital management structure and culture. Currently, most of these relationships are strained, Rao said, but you can nurture them by serving on committees, getting involved with quality and safety measures, or participating in strategic planning or marketing efforts. Jumping into the hospital culture will show that radiologists add value.

5. Manage your department: Don’t be afraid to take on more responsibility for your department’s management; Hospital administration is generally amenable to letting you do this, and you could get paid for it. Create financial targets and propose getting a portion of the savings if you meet the goal. The more you show administrators you’re a team player and can help control costs, the less likely you are to lose out to a teleradiology company, she said.

6. Control image utilization, even if it hurts: Do everything you can to make hospital leadership understand the importance of order entry and decision support systems. It might take money out of your pocket, but it’s the right thing to do for patients, Rao said. As with department management, work on an arrangement where your department and the hospital split the cost savings from reduced imaging equally.