'Anti-imaging bias' haunts radiology industry

Bruce Hillman: ACA, radiology benefit management, economy, radiology phobias creat a 'perfect storm'
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Continuous innovation has been key to the success of the radiology industry over the last four decades, according to Bruce Hillman, M.D. (pictured), a professor of radiology, medical imaging and public health sciences at the University of Virginia School of Medicine. However, in a session at the recent session at the recent Radiological Society of North America annual conference in Chicago, he said an "anti-imaging bias" continues to loom over the industry.

"There's been this perfect storm of events that has been injurious," Hillman told FierceMedicalImaging in an exclusive interview. "The 2005 Deficit Reduction Act; the likely institution of technical fee cuts related to the Affordable Care Act; the worldwide recession; an unsustainable growth in healthcare costs in which imaging has been pinpointed as a contributor; the rise of radiology benefit management companies; and radiation phobia: all of those things have combined to repress imaging utilization."

Hillman talked about potential solutions to those problems, as well as innovations he expects to see in the future.

FierceMedicalImaging: What has created this "anti-imaging" environment?

Bruce Hillman: Radiologists are fearful about further cuts to technical fees, fearful they will lose positions in hospitals, fearful of competitors like hospitals and corporate radiology companies--and they are retrenching. Young radiologists aren't getting the kind of job offers they used to get, and as the boomers eventually start to retire, the question is whether there are going to be radiologists out there to replace them. There is a worry that the specialty is becoming less attractive to medical students.

FMI: What solutions do you see on the horizon?

Hillman: First, we need to support innovation. The innovations of the future must be of a certain type if they're going to be successful. They have to appeal to patients and physicians, they have to reduce overall medical costs--not just imaging costs--and they have to support larger trends in medicine, such as 4P (predictive, preemptive, personalized and participatory) medicine.

We have to recognize the importance of research and innovation. The current situation has weakened academic centers, which are the seed corn of future renovation, so we have to financially support imaging research through foundations, and then lead research that shows the value of imaging--like outcomes and cost effectiveness and comparative effectiveness research. 

Second, we have to deal with anti-imaging bias. We need to avoid the appearance of self-interest by providing safer and more appropriate care using clinical decision support tools based on ACR appropriateness criteria, by participating in radiation dose registries and by installing true quality metrics. We also need to reduce waste by contesting marginal and unnecessary requests for examinations.

Third, as we move to a payment system, away from fee for service and toward a value driven paradigm, we are going to have to spend less time interpreting images and more time reinvigorating physician consultation, establishing consultation services directly for patients as is often done now for breast imaging, or for interventional procedures, and we're going to have to become much more involved in the goals of the health system.

FMI: You talked about a pipeline of innovations during your session. What will those innovations look like?

Hillman: There are some major trends that are going to be important. Things like moving from the gross anatomic to the sub cellular detailing of anatomy, moving from general physiology to targeted molecules for specific aspects of pathophysiology and linking diagnostics with therapeutics.

Then there's the issue of how you develop innovations that make the whole delivery of care a more efficient model than what we have now. That's the kind of imaging that will likely to be desirable or acceptable in the future.

Editor's note: This interview has been edited for length and clarity.