PAUL H. ELLENBOGEN, MD
ACR CHAIR’S MEMO
Critical Issues Facing the Profession of Radiology The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of controversy and challenge. —Martin Luther King Jr For several years at the annual meeting of the RSNA, the ACR has presented a refresher course titled “Critical Issues Facing the Profession of Radiology—An ACR Perspective.” This session has always been well received, but the number of people in the audience is relatively small. JACR provides a much larger audience, so in this column I will summarize what was said at the 2013 meeting of the RSNA. We had 5 speakers this year. I led off and introduced the other speakers. I then spoke of some critical issues: transitioning from volume to value, coping with declining reimbursement, collaboration among radiology societies, workforce issues, and increasing diversity within radiology. Next, I gave a brief discussion of dose reduction and the ACR Dose Index Registry, followed by some background and description of the content and intent of ACR Select, our decision support product with distribution by the National Decision Support Company. CT scans contribute about 25% of all ionizing radiation to the population of the United States, and that is one reason the dose index registry is limited to CT at this time. Plans are being made to add computed and digital radiography and fluoroscopy. The reasoning behind decision support is to take our appropriateness criteria and do all the imaging that is necessary and beneficial, and none that is not. This is also seen as a better solution
to guiding image utilization than that provided by radiology benefit managers. Our second speaker was Dr Bibb Allen, vice chair of the ACR Board of Chancellors, discussing issues related to advocacy and Imaging 3.0. Dr Allen explained that we are focusing on value because a significant amount of imaging care occurs before and after interpretation. Focusing on value can improve patient safety and outcomes, can be more cost effective, can increase radiologists’ relevance to the health care system, and can empower patients in their health care. He explained in detail the concepts and tenets of Imaging 3.0, and he talked about RADPAC and issues related to advocacy such as sustainable growth rate reform and self-referral. He spoke about the legislative agenda for 2013 and 2014 and how this may affect radiologists as well as primary care physicians and other specialists. Our next speaker, Dr Albert Blumberg, ACR president for 2013 and 2014, pointed out to the audience the unusual coincidence that for this year, the presidents of both the ACR and the RSNA (Dr Sarah S. Donaldson) are radiation oncologists. He spoke on several topics, including declining reimbursement for intensity-modulated and image-guided radiation therapy. In the area of self-referral as it pertains to radiation oncology, the purchase of equipment and overuse of imaging studies have been problems, particularly in urology. It was also revealed that a radiation oncology course at the American Institute for Radiologic Pathology for radiation oncology residents is under development. In
the area of research, the restructuring of RTOG and ACRIN is posing considerable challenges. Dr Kimberly Applegate, ACR speaker, dealt with critical issues related to education and academics. She spoke about finding job opportunities, workforce issues, demand for metrics, resources for training residents, and resources for lifelong learning for all radiologists. Dr Applegate quoted from the 2013 annual ACR Human Resources Commission Survey created and supervised by Dr Ed Bluth and his commission and stated that upcoming articles will discuss retirement issues, practice environment, and healthrelated issues as well as citizenship as it pertains to being a radiologist. Finally, Dr Geraldine McGinty, chair of the ACR Commission on Economics, discussed what was probably of most interest to the audience: the latest issues related to economics and government relations. She covered federal payment policy, including differences for inpatients, hospital outpatients, and radiologists’ offices; proposed and final rules for 2014; how radiologists will get paid; and a “Washington update.” She mentioned that bundled coding might reduce payments and access in 2014, especially for breast biopsies. Dr McGinty also introduced the concept of dampening to the audience, as a method to mitigate impact on individual services. Obviously, the length of this column does not allow great detail. Additional information on all of these topics is available on the ACR’s website www.acr.org. Please join us in person at the 2014 annual meeting of the RSNA.
Paul H. Ellenbogen, MD, Radiology Associates of North Texas, Texas Health Presbyterian Hospital Dallas, Department of Radiology, 8200 Walnut Hill Lane, Dallas, TX 75231; e-mail: [email protected]. ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2013.12.011
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ACR CHAIR’S MEMO
Critical Issues Facing the Profession of Radiology The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of controversy and challenge. —Martin Luther King Jr For several years at the annual meeting of the RSNA, the ACR has presented a refresher course titled “Critical Issues Facing the Profession of Radiology—An ACR Perspective.” This session has always been well received, but the number of people in the audience is relatively small. JACR provides a much larger audience, so in this column I will summarize what was said at the 2013 meeting of the RSNA. We had 5 speakers this year. I led off and introduced the other speakers. I then spoke of some critical issues: transitioning from volume to value, coping with declining reimbursement, collaboration among radiology societies, workforce issues, and increasing diversity within radiology. Next, I gave a brief discussion of dose reduction and the ACR Dose Index Registry, followed by some background and description of the content and intent of ACR Select, our decision support product with distribution by the National Decision Support Company. CT scans contribute about 25% of all ionizing radiation to the population of the United States, and that is one reason the dose index registry is limited to CT at this time. Plans are being made to add computed and digital radiography and fluoroscopy. The reasoning behind decision support is to take our appropriateness criteria and do all the imaging that is necessary and beneficial, and none that is not. This is also seen as a better solution
to guiding image utilization than that provided by radiology benefit managers. Our second speaker was Dr Bibb Allen, vice chair of the ACR Board of Chancellors, discussing issues related to advocacy and Imaging 3.0. Dr Allen explained that we are focusing on value because a significant amount of imaging care occurs before and after interpretation. Focusing on value can improve patient safety and outcomes, can be more cost effective, can increase radiologists’ relevance to the health care system, and can empower patients in their health care. He explained in detail the concepts and tenets of Imaging 3.0, and he talked about RADPAC and issues related to advocacy such as sustainable growth rate reform and self-referral. He spoke about the legislative agenda for 2013 and 2014 and how this may affect radiologists as well as primary care physicians and other specialists. Our next speaker, Dr Albert Blumberg, ACR president for 2013 and 2014, pointed out to the audience the unusual coincidence that for this year, the presidents of both the ACR and the RSNA (Dr Sarah S. Donaldson) are radiation oncologists. He spoke on several topics, including declining reimbursement for intensity-modulated and image-guided radiation therapy. In the area of self-referral as it pertains to radiation oncology, the purchase of equipment and overuse of imaging studies have been problems, particularly in urology. It was also revealed that a radiation oncology course at the American Institute for Radiologic Pathology for radiation oncology residents is under development. In
the area of research, the restructuring of RTOG and ACRIN is posing considerable challenges. Dr Kimberly Applegate, ACR speaker, dealt with critical issues related to education and academics. She spoke about finding job opportunities, workforce issues, demand for metrics, resources for training residents, and resources for lifelong learning for all radiologists. Dr Applegate quoted from the 2013 annual ACR Human Resources Commission Survey created and supervised by Dr Ed Bluth and his commission and stated that upcoming articles will discuss retirement issues, practice environment, and healthrelated issues as well as citizenship as it pertains to being a radiologist. Finally, Dr Geraldine McGinty, chair of the ACR Commission on Economics, discussed what was probably of most interest to the audience: the latest issues related to economics and government relations. She covered federal payment policy, including differences for inpatients, hospital outpatients, and radiologists’ offices; proposed and final rules for 2014; how radiologists will get paid; and a “Washington update.” She mentioned that bundled coding might reduce payments and access in 2014, especially for breast biopsies. Dr McGinty also introduced the concept of dampening to the audience, as a method to mitigate impact on individual services. Obviously, the length of this column does not allow great detail. Additional information on all of these topics is available on the ACR’s website www.acr.org. Please join us in person at the 2014 annual meeting of the RSNA.
Paul H. Ellenbogen, MD, Radiology Associates of North Texas, Texas Health Presbyterian Hospital Dallas, Department of Radiology, 8200 Walnut Hill Lane, Dallas, TX 75231; e-mail: [email protected]. ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2013.12.011
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