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From value-based care to patient interaction, experts discuss how radiology will be shaped throughout the year.
Looking back on 2018, technological advancement in radiology was the hot topic at nearly every national conference in the industry. That’s a trend that has every indication of continuing in 2019.
According to industry leaders, continued progress in artificial intelligence (AI) will largely take center stage even if wide-spread implementation continues to lag. But, alongside this progress, you’ll likely see more emphasis on patient interaction and patient-centered care, as well as a changing educational landscape for residents.
Diagnostic Imaging spoke with several thought leaders to see where they think the industry is headed over the next 12 months.
1. Artificial intelligence
The verdict is out on just how much movement radiology might see with AI, deep learning, and machine learning in 2019. But there is a consensus among industry leaders that something will happen.
“There’s been a lot of hype, hope, and fear associated with artificial intelligence,” says Vijay Rao, MD, RSNA president. “I believe, next year, we’ll continue to see the hype and the hope, but I think the fear is diminishing appropriately.”
Related article: Artificial intelligence in radiology: Friend or foe?
Eliot Siegel, MD, professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine, agrees. In fact, he predicts the industry will see advancements in how AI improves image acquisition with MRI, CT, and PET/CT. By enhancing smaller amounts of data to be equivalent to larger data sets, he says, AI will likely hasten MRI imaging time, enhance CT resolution, and enable dose reduction with PET/CT.
Acquiring AI tools could also become more convenient, he says, as the number of AI applications continues to increase.
“It’s likely that there will be a menu of multiple different applications that will be provided by platforms,” he says. “And, providers will be able to pick and choose which ones they want to use and much more tightly integrate it into their workstations.”
AI technology is also moving toward a greater ability to identify changes over time in imaging studies. This advancement could be particularly helpful, he says, with mammography studies. If AI can recognize disease progression early, then treatments and outcomes will improve.
Vendor-centric and stand-alone solutions will likely become less attractive to individual radiologists and groups in 2019, says Matthew Michela, president and chief executive officer for Life Image, a clinical information workflow organization. Clinicians and internal technology leaders could strongly resist proprietary standards and non-inoperability.
“Companies that don’t use open standards and who use protective software hold radiologists captive in silos,” he says. “Providers will push back against these vendors so they don’t have so much control.”
3. Patient empowerment
The push toward more patient-centered care isn’t new, but 2019 will likely be the year when patients assume even more control over their radiology healthcare, Rao says.
As deductibles continue to rise for a growing number of employer-provided health insurance plans, patients will become more price conscious.
“Patients will take on more financial responsibility for their tests, and they’re going to start doing their own research,” she says. “They’ll make their own decisions about where they want to have their studies done.”
Consequently, practices and groups must become more acutely aware of how their costs compare with their peers.
4. Patient interaction
Alongside greater access to medical information and control over what they spend, patients will likely continue to push for more personalized time with their providers, says Tessa Cook, MD, assistant professor of radiology at the Hospital of The University of Pennsylvania. To fulfill their request, you could have to alter how you organize your workflow, how you report, and how you engage patients.
There isn’t a cookie-cutter, one-size-fits-all solution, she says, and integrating more one-on-one time with patients has financial challenges and stressors. The current reimbursement model and current imaging workflow aren’t compatible with offering more face time to patients.
Related article: Radiologist, Meet Patient
“We’re going to have to start imagining creative workflows that let us have face time with patients,” she says. “We won’t see a solution in the next 12 months, but we’re primed to have the conversation and to brainstorm.”
Rao agrees that increasing the amount of patient interaction should be a top priority for radiologists this year.
“We aggregate a lot of our responsibilities to clinicians. We need to become more accessible to patients,” she says. “If they want to ask us questions about their results, we should be available. And, if we make follow-up recommendations on a study, we should communicate that directly to patients.”
5. Radiological divergence
There’s been a great deal of talk over the past few years about the paths that both diagnostic and interventional radiology are taking. This year could see an even greater separation, says Matt Hawkins, MD, assistant professor of pediatric radiology at Emory University School of Medicine.
In addition to taking a different academic exam, diagnostic radiology residents will continue to be exposed for a smaller percentage of interventional procedures during training, he says.
Related article: Growth of Interventional Radiology
“We’ll continue to have different residency curricula, different clinical emphasis, and procedural work will be done less and less by diagnostic radiologists,” he says. “It’s hard to imagine how they won’t continue to diverge. It doesn’t mean that it’s good or bad-we’ll just need to continue to work together to try to maintain relationships.”
6. Less emphasis on value-based payments
The past few years has seen frenzied movements in the industry to prepare for the switch from a fee-for-service based model to a value-based payment system. Look for that activity to decline, Hawkins says.
“With changes to ObamaCare and delays with MACRA and quality payment plans, I think you’ll see a lot of roll back on the emphasis on more value-based payments,” he says. “And, if that’s the case, you’ll see more attention on fee-for-service mechanisms.”
In that vein, he says, the industry could turn attention to less traditionally-discussed aspects of reimbursement, such as the Hospital Outpatient Prospective Payment System. It could also focus on other factors that impact reimbursement other than straightforward CPT professional and technical reimbursement.
“I think people realize that value-based payments were probably over-emphasized,” he says. “It’s probably something that’s 10-to-15 years off in the future.”
Even with all the forward movement, the industry still faces challenges for the coming year.
One of the biggest stumbling blocks, Rao says, will be convincing your referring clinicians that you’re the experts with imaging and should be able to communicate directly with patients. Many ordering providers are reluctant to cede that control, so overcoming the barrier will take effort at both the national and grass-roots level.
Additionally, Hawkins says, the industry could see the perfect storm of increasing utilization and decreasing reimbursement.
Related article: 7 Radiology Resolutions for the New Year
“If that happens, it will continue the vicious cycle of having to do more work to get the same bottom line,” he says. “And, because value-based reimbursement hasn’t happened as quickly as we thought, if cuts in payment continue, we might go further down the workload cycle we’ve been seeing since 2008-2009.”
Ultimately, he says, 2019 should be a year when radiology focuses on shorter-term goals that can be more readily accomplished.
“In my dreams, 2019 is the year we could refocus on what is important now and make changes for now,” he says. “Keep an eye on the long game.”