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What to Watch in 2011
By Jim Knaub

Some radiologists are reporting technical component payment reductions in the neighborhood of 25% for performing some CT exams in 2011. With many advanced imaging procedures experiencing another round of large reimbursement cuts, I wonder whether these cuts alone will erode the growth of self-referral imaging among the nonradiologists who provide these exams under in-office exemption? Many in the imaging community have suggested the outpatient cuts will drive more imaging back to hospitals. Or will these cuts simply trigger the more traditional volume increase response among self-referrers?

Another interesting economic question in 2011 is whether the economic turnaround will gather speed. Some of the slowing in imaging growth since 2006 can be attributed to the recession; just how much isn’t clear. Imaging cuts, the recession, slow recovery, and spreading preauthorization requirements all contributed to slowing imaging volume. Apportioning their relative impact is impossible.

The changing of the guard in the House of Representatives may result in an attempt to repeal or alter the last year’s healthcare reform legislation. How that affects the imaging economy this year is anyone’s guess, but don’t expect the reform debate to end anytime soon.

Another interesting business issue to watch in the coming year will be how teleradiology affects radiology practice. Six or seven years ago, radiology was buzzing about image overload and wondering how the current shortage of radiologists would ever handle both the explosion of exams being performed and the growing number of images in CT or MR exams. Back then, image overload was tagged as a major issue for coming decade, but you don’t read much about it anymore.

Teleradiology technology’s capability to distribute imaging exams to wherever radiologists are available to interpret them is probably the single largest reason why the issue has faded. What threatens radiologists is that image flow can be away from their practices as well as toward them. Doctors used to talk confidently about how healthcare was the ultimate, inevitable local business. Good care generally requires highly skilled people in a specific location. Telemedicine is nibbling at the edges of that concept across specialties, but radiology is far ahead of the curve in depending less on the physician’s physical location. Teleradiology is the technologic tool that makes it possible.

Organizations such as Virtual Radiologic Corporation (vRad), Radisphere, and Imaging Advantage are just different efforts to compete in the changing world of delivering radiology services. Given that vRad’s acquistion of NightHawk Radiology Services went down at the end of the 2010, it will be interesting and important to see how the now-larger company affects radiology practice—and how radiology practices responds.

Finally, dose management, measurement, and reporting will continue to draw serious attention. The radiology community is tackling how to better manage, measure, and report the radiation dose associated with imaging exams. RSNA and the ACR recently launched their Image Wisely education and awareness campaign. Modality vendors at RSNA 2010 were showing their latest tools for dose management, along with how they envision integrating them into imaging workflow.

— Jim Knaub is editor of Radiology Today.