What if Radiology Turns Out Exactly the Way We Predict it Will?

I learned a long time ago not to pay too much attention to the “death by a thousand cuts” in radiological reimbursements. It’s “not happy making,” as my aunt would say nor is it something over which I have any control. Plus, sooner or later the intel will find me.

For example, a post on radiology social media, a couple of weeks ago, lamented the bundling of CTA head/neck as of 2026. For all I know, that news was hot off the presses but it could just as easily have been circulating weeks earlier. Alternately, I may hear of this news months from now, even in 2026 itself, and I doubt the timing of my awareness would have had any impact on my reaction.

Part of that is because I. have been in the rad workforce long enough to have seen this before. I remember when abdomen/pelvis CTs got bundled. It was the first time I had heard of such a thing, and I got good and worked up about it then. My vexation failed to change the course of history.

That didn’t stop me from venting about it, and I wasn’t alone in making dire predictions about what it and things like it would do to rads and health care as a whole. The social media thread’s comments showed that times haven’t changed much. Some folks predicted negative impacts this bundling will have whereas others talked about how it should have been no surprise to anyone.

One example of the latter provokes the following thoughts: “ER over orders an exam. Radiology gets paid for the over ordering. CMS realized it is being over ordered and cuts prices. Cycle repeats in the name of budget neutrality. All doctors suffer in this system. Every professional society is picking at the same carcass every year. Doctors are probably the only professional group that gets paid less in inflation-adjusted numbers over time.”

Forward-looking predictions predominated in part because it is the closest we can usually get to responding to these things over which we have zero control. You are doing X to us? We predict a bunch of negative consequences of X, and we look forward to saying “We told you so” when you suffer those consequences someday.

Bitter humor often punctuates these predictions. “Looks like my CTA reports will be getting substantially shorter in 2026.” “If you adjust your reporting effort to be commensurate with wRVU, you will never be disappointed.” “Now those routine CTA H/N outpatient exams will be ordered a week apart.”

These predictions aren’t hard to make. Most of them are based in common sense and an understanding of human nature. The fundamental principles are along the lines of: Reward something, and you will get more of it. Punish it and you will get less. The folks doing the reimbursement cutting aren’t somehow unaware of these notions but that doesn’t stop them from going ahead with their policymaking.

It puts me in mind of a recurring theme from a podcast I like: What if everything is exactly what it looks like? (Or, in this context, what if everything turns out exactly the way it looks like it will?)

The podcaster most frequently invokes that theme when making fun of “scientific” studies one can find in the news every day with outcomes you really didn’t need any science or studying to predict. As he might put it, “You didn’t need to spend all that time and money studying this. You could have just asked me.” Things like “People who get adequate sleep are healthier and happier,” or “Organized people enjoy more professional success.”

Over the years, I have seen repeated instances of “just ask us” in radiology as well as the larger world of health care. One that leaps to mind is the upswing of noctors ordering (and interpreting) imaging that they don’t understand. The excuses given for allowing this include a shortage of radiologists and the need for greater throughput in places like ERs. There is also babble about how the noctors are cheaper and it will save resources in the health-care system.

Most rads, the moment they hear such things, dismiss them out of hand. We know that supplanting professionals with less-educated/trained individuals will create more problems than it solves. “Everything turning out exactly the way it looks like it will” then unfolds with non-docs ordering far more studies (both the wrong exams to begin with as well as follow-ups), consultants to deal with what the studies showed, etc. The system gets even more overtaxed, not relieved.

How do such bad policies get enacted when so many of the folks involved can see upfront what disasters they will be? It reminds me of something once told to me by a lifelong friend who has worked his way up a corporate hierarchy.

His workplace had a bunch of creative types, folks who tended to have disparate viewpoints that made for discord. At times it felt like herding cats (not unlike dealing with a bunch of health-care professionals). Getting people on board with a new or different way of doing things, even when the existing approach wasn’t getting great results, could be a tussle.

One way he had learned to break ideological logjams, or just to move things along: “Let’s just try (whatever he was proposing at the time). If it doesn’t work, we can try something else later.”

Something about that struck me as a little slimy at the time, but I think I was too young and inexperienced to put my finger on it. Now I know. In all but the smallest organizations, undoing something is many times harder than it was to do in the first place. “Let’s just try” something that has got a strong chance of going wrong is sort of like infecting someone with a virus to see if it has any beneficial effect, and worrying later on about how you will treat the virus if it doesn’t.

In the case of “trying” noctors in place of rads, we are well past the point of demonstrating that, yes, things turned out exactly the way most of us rads thought it would but there is no serious talk about removing their radiological privileges. The camel’s nose is already in the tent, and momentum is all about how more, not less, noctor radiology will be coming down the pike.