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Academic Radiology in the New Health Care Delivery Environment

      Rationale and Objectives

      Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States.

      Materials and Methods

      To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this article, we review the expected features of the new health care environment from the perspective of academic radiology departments.

      Conclusions

      Our review will include background on accountable care organizations, identify challenges associated with the new managed care model, and outline key strategies—including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management—that will ensure continued success for academic radiology.

      Key Words

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      References

        • Fineberg H.V.
        Shattuck Lecture. A successful and sustainable health system–how to get there from here.
        N Engl J Med. 2012; 366: 1020-1027
        • Davis K.
        • SC
        • Stremikis K.
        Mirror, mirror on the wall: how the performance of the U.S. health care system compares internationally.
        Commonwealth Fund, New York2010
      1. Yong P.L. Saunders R.S. Olsen L.A. The healthcare imperative: lowering costs and improving outcomes: workshop series summary. The National Academies Press, Washington, DC2010
        • McCarthy D.
        • Howe S.K.H.
        • Schoen C.
        • et al.
        Aiming higher: results from a state scorecard on health system performance.
        The Commonwealth Fund, New York, NY2009
        • Fisher E.S.
        • Wennberg D.E.
        • Stukel T.A.
        • et al.
        The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care.
        Ann Intern Med. 2003; 138: 273-287
        • Landon B.E.
        Keeping score under a global payment system.
        N Engl J Med. 2012; 366: 393-395
      2. Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012; Final Rule. Fed Reg 2012; 76:288.

      3. Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013. Fed Reg 2012; 77:222.

        • Seidel R.L.
        • Baumgarten D.A.
        Pay for performance: survey of diagnostic radiology faculty and trainees.
        J Am Coll Radiol. 2007; 4: 411-415
        • Moser J.W.
        • Wilcox P.A.
        • Bjork S.S.
        • et al.
        Pay for performance in radiology: ACR white paper.
        J Am Coll Radiol. 2006; 3: 650-664
        • McVey L.R.
        Pay-for-performance radiology: a new concept.
        Radiol Manage. 1999; 21: 18-21
        • Allen Jr., B.
        • Levin D.C.
        • Brant-Zawadzki M.
        • et al.
        ACR white paper: strategies for radiologists in the era of health care reform and accountable care organizations: a report from the ACR Future Trends Committee.
        J Am Coll Radiol. 2011; 8: 309-317
        • Becker G.J.
        • Bosma J.L.
        • Burleson J.
        • et al.
        Introduction to value-based payment modifiers.
        J Am Coll Radiol. 2012; 9: 718-724
        • Enzmann D.R.
        Radiology's value chain.
        Radiology. 2012; 263: 243-252
        • Kahn Jr., C.E.
        Artificial intelligence in radiology: decision support systems.
        Radiographics. 1994; 14: 849-861
        • Rosenthal D.I.
        • Weilburg J.B.
        • Schultz T.
        • et al.
        Radiology order entry with decision support: initial clinical experience.
        J Am Coll Radiol. 2006; 3: 799-806
        • Kaplan B.
        Evaluating informatics applications–clinical decision support systems literature review.
        Int J Med Inform. 2001; 64: 15-37
        • Miller R.A.
        Medical diagnostic decision support systems–past, present, and future: a threaded bibliography and brief commentary.
        J Am Med Inform Assoc. 1994; 1: 8-27
        • Kruskal J.B.
        • Reedy A.
        • Pascal L.
        • et al.
        Quality initiatives: lean approach to improving performance and efficiency in a radiology department.
        Radiographics. 2012; 32: 573-587
        • Ondategui-Parra S.
        • Bhagwat J.G.
        • Gill I.E.
        • et al.
        Essential practice performance measurement.
        J Am Coll Radiol. 2004; 1: 559-566
        • Johnson C.D.
        • Krecke K.N.
        • Miranda R.
        • et al.
        Quality initiatives: developing a radiology quality and safety program: a primer.
        Radiographics. 2009; 29: 951-959
        • Mendiratta-Lala M.
        • Eisenberg R.L.
        • Steele J.R.
        • et al.
        Quality initiatives: measuring and managing the procedural competency of radiologists.
        Radiographics. 2011; 31: 1477-1488
        • Lee C.I.
        • Enzmann D.R.
        Measuring radiology's value in time saved.
        J Am Coll Radiol. 2012; 9: 713-717
        • Thompson T.G.
        • Brailer D.J.
        The decade of health information technology: delivering consumer-centric and information-rich health care.
        US Department of Health and Human Services, Washington, DC2004
        • Chaudhry B.
        • Wang J.
        • Wu S.
        • et al.
        Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.
        Ann Intern Med. 2006; 144: 742-752
        • Blumenthal D.
        Stimulating the adoption of health information technology.
        N Engl J Med. 2009; 360: 1477-1479
        • Flanagan P.T.
        • Relyea-Chew A.
        • Gross J.A.
        • et al.
        Using the internet for image transfer in a regional trauma network: effect on CT repeat rate, cost, and radiation exposure.
        J Am Coll Radiol. 2012; 9: 648-656
        • Buntin M.B.
        • Burke M.F.
        • Hoaglin M.C.
        • et al.
        The benefits of health information technology: a review of the recent literature shows predominantly positive results.
        Health Affairs. 2011; 30: 464-471
        • Channin D.S.
        • Bowers G.
        • Nagy P.
        Should radiology IT be owned by the chief information officer?.
        J Digit Imaging. 2009; 22: 218-221
        • Arenson R.L.
        PACS: current status and cost-effectiveness.
        Eur Radiol. 2000; 10: S354-S356
        • Roberson G.H.
        • Shieh Y.Y.
        Radiology information systems, picture archiving and communication systems, teleradiology–overview and design criteria.
        J Digit Imaging. 1998; 11: 2-7
        • Boochever S.S.
        HIS/RIS/PACS integration: getting to the gold standard.
        Radiol Manage. 2004; 26 (quiz 25–27): 16-24
        • Sung J.C.
        • Sodickson A.
        • Ledbetter S.
        Outside CT imaging among emergency department transfer patients.
        J Am Coll Radiol. 2009; 6: 626-632
        • Gupta R.
        • Greer S.E.
        • Martin E.D.
        Inefficiencies in a rural trauma system: the burden of repeat imaging in interfacility transfers.
        J Trauma. 2010; 69: 253-255
        • Pitts S.R.
        • Niska R.W.
        • Xu J.
        • et al.
        National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary.
        Natl Health Stat Report. 2008; : 1-38
        • Pinthus J.H.
        • Farrokhyar F.
        • Hassouna M.M.
        • et al.
        Single-session primary high-intensity focused ultrasonography treatment for localized prostate cancer: biochemical outcomes using third generation-based technology.
        Br J Urol Int. 2012; 110: 1142-1148
        • Rouviere O.
        • Glas L.
        • Girouin N.
        • et al.
        Prostate cancer ablation with transrectal high-intensity focused ultrasound: assessment of tissue destruction with contrast-enhanced US.
        Radiology. 2011; 259: 583-591
        • Kim H.S.
        • Baik J.-H.
        • Pham L.D.
        • et al.
        MR-guided high-intensity focused ultrasound treatment for symptomatic uterine leiomyomata: long-term outcomes.
        Acad Radiol. 2011; 18: 970-976
        • Kim Y.-S.
        • Kim J.-H.
        • Rhim H.
        • et al.
        Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes.
        Radiology. 2012; 263: 600-609
        • Cho Z.-H.
        • Kang C.-K.
        • Han J.-Y.
        • et al.
        Observation of lenticulostriate arteries in the human brain in vivo using 7.0T MR angiography.
        Stroke. 2008; 39: 1604-1606
        • Conijn M.M.
        • Geerlings M.I.
        • Biessels G.J.
        • et al.
        Cerebral microbleeds on MR imaging: comparison between 1.5 and 7T.
        Am J Neuroradiol. 2011; 32: 1043-1049
        • Manglaviti G.
        • Tresoldi S.
        • Guerrer C.S.
        • et al.
        In vivo evaluation of the chemical composition of urinary stones using dual-energy CT.
        AJR Am J Roentgenol. 2011; 197: W76-W83
        • Song K.D.
        • Kim C.K.
        • Park B.K.
        • et al.
        Utility of iodine overlay technique and virtual unenhanced images for characterization of renal masses by dual-energy CT.
        AJR Am J Roentgenol. 2011; 197: W1076-W1082
        • Neville A.M.
        • Gupta R.T.
        • Miller C.M.
        • et al.
        Detection of renal lesion enhancement with dual-energy multidetector CT.
        Radiology. 2011; 259: 173-183
        • Massoud T.F.
        Molecular imaging in living subjects: seeing fundamental biological processes in a new light.
        Genes Develop. 2003; 17: 545-580
        • Contag C.H.
        In vivo pathology: seeing with molecular specificity and cellular resolution in the living body.
        Annu Rev Pathol Mech Dis. 2007; 2: 277-305
        • Miller J.C.
        • Thrall J.H.
        Clinical molecular imaging.
        J Am Coll Radiol. 2004; 1: 4-23
        • Weissleder R.
        • Mahmood U.
        Molecular imaging.
        Radiology. 2001; 219: 316-333
        • Margulis A.R.
        Molecular imaging: love it or lose it.
        Radiology. 2012; 264: 5
        • Nathan D.G.
        • Varmus H.E.
        The National Institutes of Health and clinical research: a progress report.
        Nat Med. 2000; 6: 1201-1204
        • Lee C.I.
        • Forman H.P.
        What we can and cannot see coming.
        Radiology. 2010; 257: 313-314
        • Budoff M.J.
        • Hamirani Y.S.
        • Gao Y.L.
        • et al.
        Measurement of thoracic bone mineral density with quantitative CT.
        Radiology. 2010; 257: 434-440
        • Shemesh J.
        • Henschke C.I.
        • Shaham D.
        • et al.
        Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.
        Radiology. 2010; 257: 541-548
        • Gondrie M.J.
        • Mali W.P.
        • Jacobs P.C.
        • et al.
        Cardiovascular disease: prediction with ancillary aortic findings on chest CT scans in routine practice.
        Radiology. 2010; 257: 549-559
        • Krestin G.P.
        Maintaining identity in a changing environment: the professional and organizational future of radiology.
        Radiology. 2009; 250: 612-617
        • Arenson R.
        • Dunnick N.R.
        Training a better radiologist.
        J Am Coll Radiol. 2006; 3: 389-393
        • Campbell E.G.
        • Weissman J.S.
        • Blumenthal D.
        Relationship between market competition and the activities and attitudes of medical school faculty.
        JAMA. 1997; 278: 222-226
        • Enzmann D.R.
        • Schomer D.F.
        Analysis of radiology business models.
        J Am Coll Radiol. 2012; 10: 175-180
        • Levin D.C.
        • Rao V.M.
        Turf wars in radiology: introduction.
        J Am Coll Radiol. 2004; 1: 23-25
        • Levin D.C.
        • Rao V.M.
        Turf wars in radiology: the overutilization of imaging resulting from self-referral.
        J Am Coll Radiol. 2004; 1: 169-172
        • Hendee W.R.
        An opportunity for radiology.
        Radiology. 2006; 238: 389-394
        • Amis Jr., E.S.
        • Dunnick N.R.
        Improvement in radiology education: joint efforts of the American Board of Radiology and the Diagnostic Radiology Residency Review Committee.
        J Am Coll Radiol. 2009; 6: 103-105
        • Breslau J.
        • Lexa F.J.
        A radiologist's primer on accountable care organizations.
        J Am Coll Radiol. 2011; 8: 164-168
        • Nachiappan A.C.
        • Wynne D.M.
        • Katz D.P.
        • et al.
        A proposed medical physics curriculum: preparing for the 2013 ABR examination.
        J Am Coll Radiol. 2011; 8: 53-57
        • Nachiappan A.C.
        • Lee S.R.
        • Willis M.H.
        • et al.
        Clinically oriented three-year medical physics curriculum: a new design for the future.
        AJR Am J Roentgenol. 2012; 199: 635-643
        • Shortell S.M.
        • Casalino L.P.
        • Fisher E.S.
        How the center for Medicare and Medicaid innovation should test accountable care organizations.
        Health Aff (Millwood). 2010; 29: 1293-1298
        • Bernardy M.
        • Ullrich C.G.
        • Rawson J.V.
        • et al.
        Strategies for managing imaging utilization.
        J Am Coll Radiol. 2009; 6: 844-850
        • Hillman B.J.
        • Goldsmith J.C.
        The uncritical use of high-tech medical imaging.
        N Engl J Med. 2010; 363: 4-6
        • Levin D.C.
        • Rao V.M.
        Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging.
        J Am Coll Radiol. 2008; 5: 806-810
        • Hillman B.J.
        • Joseph C.A.
        • Mabry M.R.
        • et al.
        Frequency and costs of diagnostic imaging in office practice–a comparison of self-referring and radiologist-referring physicians.
        N Engl J Med. 1990; 323: 1604-1608
        • Berbaum K.S.
        • Franken Jr., E.A.
        • el-Khoury G.Y.
        Impact of clinical history on radiographic detection of fractures: a comparison of radiologists and orthopedists.
        AJR Am J Roentgenol. 1989; 153: 1221-1224
        • Loy C.T.
        • Irwig L.
        Accuracy of diagnostic tests read with and without clinical information: a systematic review.
        JAMA. 2004; 292: 1602-1609
        • Mullins M.E.
        • Lev M.H.
        • Schellingerhout D.
        • et al.
        Influence of availability of clinical history on detection of early stroke using unenhanced CT and diffusion-weighted MR imaging.
        AJR Am J Roentgenol. 2002; 179: 223-228
        • Chiunda A.B.
        • Mohammed T.L.
        Knowledge of ACR thoracic imaging Appropriateness Criteria(R) among trainees: one institution's experience.
        Acad Radiol. 2012; 19: 635-639
        • Bautista A.B.
        • Burgos A.
        • Nickel B.J.
        • et al.
        Do clinicians use the American College of Radiology appropriateness criteria in the management of their patients?.
        AJR Am J Roentgenol. 2009; 192: 1581-1585
        • Blackmore C.C.
        • Mecklenburg R.S.
        • Kaplan G.S.
        Effectiveness of clinical decision support in controlling inappropriate imaging.
        J Am Coll Radiol. 2011; 8: 19-25
        • Georgiou A.
        • Prgomet M.
        • Markewycz A.
        • et al.
        The impact of computerized provider order entry systems on medical-imaging services: a systematic review.
        J Am Med Inform Assoc. 2011; 18: 335-340
        • Sanders D.L.
        • Miller R.A.
        The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies.
        Proc AMIA Symp. 2001; : 583-587
        • Cascade P.N.
        The American College of Radiology. ACR Appropriateness Criteria project.
        Radiology. 2000; 214: 3-46
        • Khorasani R.
        • Silverman S.G.
        • Meyer J.E.
        • et al.
        Design and implementation of a new radiology consultation service in a teaching hospital.
        AJR Am J Roentgenol. 1994; 163: 457-459
        • Basu P.A.
        • Ruiz-Wibbelsmann J.A.
        • Spielman S.B.
        • et al.
        Creating a patient-centered imaging service: determining what patients want.
        AJR Am J Roentgenol. 2011; 196: 605-610
        • Berlin L.
        Communicating results of all radiologic examinations directly to patients: has the time come?.
        AJR Am J Roentgenol. 2007; 189: 1275-1282
        • Berlin L.
        Communicating results of all outpatient radiologic examinations directly to patients: the time has come.
        AJR Am J Roentgenol. 2009; 192: 571-573
        • Brandt-Zawadski M.
        • Kerlan R.K.
        Patient-centered radiology: use it or lose it!.
        Acad Radiol. 2009; 16: 521-523
        • Kuhlman M.
        • Meyer M.
        • Krupinski E.A.
        Direct reporting of results to patients: the future of radiology?.
        Acad Radiol. 2012; 19: 646-650
        • Margulis A.R.
        • Sostman H.D.
        Radiologist-patient contact during the performance of cross-sectional examinations.
        J Am Coll Radiol. 2004; 1: 162-163
        • Berlin L.
        Failure of radiologic communication: an increasing cause of malpractice litigation and harm to patients.
        App Radiol. 2010; 39: 17-23
        • Yetisgen-Yildiz M.
        • Gunn M.L.
        • Xia F.
        • et al.
        Automatic identification of critical follow-up recommendation sentences in radiology reports.
        AMIA Annu Symp Proc. 2011; 2011: 1593-1602
      4. Radiology and primary care in Europe.
        Insights imaging. 2010; 1: 46-52
        • Apthorp L.A.
        • Daly C.A.
        • Morrison I.D.
        • et al.
        Direct access MRI for general practitioners–influence on patient management.
        Clin Radiol. 1998; 53: 58-60
        • Knechtges P.M.
        • Carlos R.C.
        The evolving role of radiologists within the health care system.
        J Am Coll Radiol. 2007; 4: 626-635
        • Royal College of General Practitioners
        Clinical radiology and the patients of general practitioners: joint statement of the Royal College of General Practitioners and Royal College of Radiology.
        The Royal College of Radiologists, London, UK2004