Pardon the earthquake metaphor, but my base is here in sunny Southern California, and although most of the states contend with rain, snow, and dropping temperatures at this time of year, our primary concerns are unrelenting ultraviolet radiation … and earthquakes.

But the metaphor is apt, as the past year has delivered an unprecedented number of shock waves to the imaging industry. How individual practices and organized radiology address the challenges arising from this tectonic activity will determine in large part how well radiology will meet its future.

The Deficit Reduction Act of 2005. Passed in the waning days of 2005, the DRA has consumed the best efforts of many in organized radiology during the past year, with impressive results. An Access to Medical Imaging Act that was introduced in both houses of Congress would institute a moratorium on the proposal to cap outpatient imaging center reimbursement at hospital rates, but no health care bill has emerged from Congress to date. All eyes are on Washington and will remain there until December 31, 2006, but most practices and outpatient imaging centers have built budgets on the expectation of significantly reduced reimbursement. Congress already has exhibited a cavalier willingness to overlook reason in favor of results. Nonetheless, this is a wrong that radiology must continue to work to rectify.

The 2007 Medicare Physician Fee Schedule. Like a one-two punch, along came the 2007 MPFS and its little bouquet of surprises for outpatient imaging centers. Though aimed at some questionable business models in the pathology laboratory world, the new regulations in the 2007 MPFS, designed to put a short leash on pathology labs, nonetheless impact all independent diagnostic testing facilities (IDTFs), including outpatient imaging centers. Those regulations include sharp new restrictions on physician oversight (one physician can oversee no more than three IDTFs) and advertising. However, CMS has elected to not apply the new reassignment rule restrictions for laboratories to radiology. On the one hand, hospital-based radiology groups can continue to assign the professional fee to US-based teleradiology companies and, therefore, sleep on through the night. Likewise, self-referring physicians with all of that imaging equipment in their offices are breathing a collective sigh of relief. CMS intends to further explore the option of extending this limitation to radiology. Not described here are a half dozen more restrictions on IDTF operations. So, whereas reimbursement has been reduced, oversight—and the cost of complying with this oversight—has been increased.

The Emergence of Coronary CT Angiography. When 64-slice began to ship, many saw the writing on the wall: diagnostic angiography is on its way out, probably within 2 years. Will this translate into increased CT volume for radiologists and an opportunity to get reacquainted with the heart? Or will cardiology take the lead? Get involved and help create a future for radiology in this realm.

Price Transparency. The onset of consumerism in health care has been predicted and commented on for several years, but when he adopted the idea as a pet project, President Bush moved the notion into the mainstream. It is an idea that the late economist Milton Friedman might have approved: a self-regulating mechanism that could have a positive influence on the market. Hospitals, imaging centers, and radiology departments should spend time thinking about what this will mean to them if the idea continues to pick up steam. Those inflated prices that no one pays are not going to cut the mustard with consumers.

Pay for Performance (P4P). This is another movement that Congress has fast-tracked, and organized radiology is currently scrambling to come up with some measures that the American Medical Association can turn over to Congress. So-called P4P programs—actually thinly disguised utilization management initiatives—already have saddled some markets with an onerous new layer of clerical work. The looming question for radiology is this: How do you measure clinical quality? The answer to that question will have direct bearing on the issue that follows.

The Rise of the Dayhawk. In retrospect, it was inevitable that dayhawks follow nighthawks into the health care market for radiology. Practices are perennially undermanned, and some hospitals in rural areas cannot occupy a single radiologist full-time. That said, radiology practices will have to work hard to add value to the hospital if they intend to keep local radiology alive.

In the final analysis of 2006, and for many reasons, radiology is a wonderful field in which to labor. But clearly, the business environment is evolving almost as rapidly as the technologies. If there is one thing to remember moving into 2007, be sure to accurately assess the cost of delivering the radiology service as well as its considerable value to patient care today. And vigorously defend any attempts to devalue that.

Readers, I wish you health and well-being in the new year.

Cheryl Proval
Editorial Director