Krishna Nallamshetty, M.D., President, Radiology Associates of Florida & Executive Vice President of Radiology Partners

The COVID-19 pandemic has been a major disruptor for the healthcare industry. Over the past few weeks, we have witnessed how an essential need in modern society like medical imaging can be abruptly curtailed.

Radiology practices have experienced declines in volumes never seen before, or maybe even imagined. These reductions have occurred throughout the country due to governmental-based restrictions on movement and limitations on non-urgent imaging, as well as patient cancellations and no-shows due to fear of viral exposure. Many radiology volumes have declined by 

, with even greater reductions in outpatient volumes. The most severely impacted practices are those in COVID-19 hot spot areas where many centers have been forced to close their operations almost completely. Interestingly, interventional radiology volumes declined to a lesser extent. Inpatient procedures are a continued necessity, and many outpatient interventional procedures are considered essential even during this crisis.
	
	Imaging volume reductions have resulted in a significant decline in radiology practice revenues. This has put extraordinary stress on practice operations and staffing. Especially for practices with owned or joint-ventured imaging centers, the loss of both technical and professional revenues has resulted in challenges sustaining their businesses. Imaging center staff have experienced decreases in work hours and in some instances been furloughed or lost their jobs. These staffing adjustments are complicated by requests from staff members who may have conditions that place themselves or a family member at elevated risk should they get sick or have to juggle childcare due to school closures.

Physicians in radiology practices have experienced similar staffing and financial challenges. Physician compensation adjustments are common, ranging anywhere from 20 percent-to-50 percent or more in temporary salary reductions. Teleradiology-based practices have lost significant volume as traditional practices have shifted previously outsourced imaging internally, in order to decrease expenses and support revenues. This has resulted in a rise in unemployment among locum and part-time radiologists.
	
	As a result of these challenges, radiology practices have evolved and are discovering unique opportunities that will likely result in permanent changes in the post-pandemic era. Practices are becoming extremely focused on cost reduction and running lean operations. They are re-examining their workflow and innovating remote solutions. To do so, they are engaging with hospital leadership and other client teams to build on the technology infrastructure to allow interpretation of diagnostic imaging off-site. This includes PACs, dictation systems, electronic health record (EHR) programs, and third-party advanced visualization tools. Those practices with home diagnostic workstations quickly shifted some of their workforce home while others may have shifted from a hospital-based to office-based environment. This has demonstrated to many hospitals and imaging clients that a combination of on-site and remote physicians can provide the care patients need.

Referring physicians have increased use of virtual consults with radiologists via mobile videoconferencing. This has provided flexibility for the referring physician to get consults without having to visit a radiology reading room. Likewise, it has provided flexibility for the radiologists to work remotely from alternative sites and get comfortable with virtual face-to-face conversations instead of traditional in-person consults or phone calls.

The pandemic has accelerated radiology’s role in the utilization management of medical imaging. It has pushed referring physicians and patients to think carefully about the exams they order and undergo, respectively. Physicians have become more conscientious about their imaging recommendations, relying heavily on clinical judgement to minimize potential viral exposures. This has resulted in more appropriate use of imaging procedures and interventions.

Interventional radiology has been in the spotlight, as it is hospital-based and on the frontline, often taking on procedures other specialties may have avoided. This commitment to patient care, along with the ability to maintain diagnostic interpretations seamlessly in a crisis, should be highlighted by radiology practices with their hospital leadership.
	
	Another unexpected positive consequence of the COVID-19 pandemic is the demonstration of leadership among radiologists. Radiologists have stepped up during this crisis in order to stabilize their practices. This has provided an opportunity for younger radiologists to get involved and may be a steppingstone for future leadership roles within their practices.

Finally, since the effects of this pandemic were beyond anyone’s control, there has been greater understanding of the operational disruptions. This has fostered a strong culture of teamwork and re-commitment to patient care. This culture will be essential to a successful recovery in the months to come.

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From changes to revenue, imaging utilization, and workflow, COVID-19 has changed the face radiology in today's healthcare environment.

Author | Krishna Nallamshetty, M.D., President, Radiology Associates of Florida & Executive Vice President of Radiology Partners

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