With reform in the air I continue to hear a word spoken that brings fear into the hearts of those in the Diagnostic Imaging profession: commoditization. This concept is driving Radiology groups, clinics, imaging centers, directors and managers to think about the future and how it will change for this specialty. With as many different perspectives as there are interested parties I wonder if, between the fear-mongers and the Utopians, there is a reasonable approach to consider. Are we doomed to Wal-Mart radiology? Will Nighthawk groups take over the world? Will all of this just be much ado about nothing? I don't think anyone can say with confidence where it will end. But it's fair to say we've created our own problem.
To understand our problem we have to look at our recent history. Several years ago as PACS began sweeping the Radiology and Imaging world several key changes took place that changed how we do business. The first was a change in the way physicians interact with Radiologists. When Diagnostic Imaging was tethered to film, doctors commonly consulted in-person with Radiologists at the beginning of their shift. A quick stop by the reading room to review patient films and discuss was part of preparation. This interaction, formally or casually, was in person and consultative by nature. Once PACS arrived and images were distributed digitally to workstations on every floor of the hospital this one-to-one interaction disappeared. While a distributed image solution created a convenient way to access images and reports anywhere, it unlinked to the personal interaction between physicians and Radiologists.
At the same time, PACS considerably changed the workflow for Radiologists. PACS as a technology solution created new efficiencies in reading exams. Radiologists quickly began pursuing ways to gain efficiency and increase volume; both of which became Key Performance Indicators for many Radiology groups. More exams and reports per Radiologist per day translated into greater income. It became a way, as proven with many other industries, to grow business through the adoption of technology. With PACS image quality increased and report turnaround times decreased, both improving patient care. Seemingly a win-win outcome.
Enter the law of unintended consequences.
While both of these shifts in how business was conducted were perceived as positive (quick, easy access to images and improved report turnaround times), they were accompanied by an important change that has lead the profession down the path of becoming commoditized. Simply, as physicians now access images and reports independently via workstation, the importance of the physician/Radiologist relationship has waned. This change in the importance of personal interaction has redefined the role of Radiologist from consultant to report vendor. It replaced a professional relationship with a function. Function will always become a commodity.
With all of the changes taking place we are being asked to do more with less. Physicians are now forced to look for ways to cut costs; and they are making decisions the same way we all do - based on both function and value. They will look beyond historical relationships and even proximity when choosing a report vendor. Enter the "Wal-Mart Radiology" concept: commoditization.
To succeed in the next wave of healthcare reform Radiology groups and Diagnostic Imaging departments will either go the way of Wal-Mart looking for profitability in large volumes, or they are going to have to return to the consulting profession. Cutting costs through workflow optimization for most is now an exercise in the law of diminishing returns. I believe there will be a place for both in the new world. For those wanting to stay local and realize success without becoming part of the borg would be best served by increasing value over volume. Become imaging consultants to your doctors through value propositions such as decision support, ongoing education and relationship development. Your expertise cannot be commoditized and will prove to be a lever in reducing costs and improving outcomes.
It's survival of the fittest. What are you doing to position yourself for the future?
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