By Chris Hobson, Imaging 3.0 content manager
ACR Bulletin 

Many factors have driven radiology to the sidelines when it comes to providing direct, quality patient care. Chief among these is the fact that, with the advent of PACS, imaging specialists can be seen by referring providers and hospital administrators as interchangeable, offering the same services with relatively little difference in quality.

It was with great interest that I watched a recent presentation by Geoffrey D. Rubin, MD, MBA, FACR, professor of radiology and bioengineering at Duke University, in which Rubin introduced the idea of incorporating concepts from Uber’s successful ride-sharing service into radiology. Doing so, noted Rubin, would introduce positives and negatives into the equation, but in the end could help to bolster the case for direct radiologist involvement in patient care.

When looked at through the lens of patient-centered radiology, the idea sounds intriguing. After all, Uber is a successful company that, as Rubin pointed out, provides customers with a number of benefits, including ease in finding a provider for a particular task and an estimate of the service's cost before it is delivered.

Great, right? Making it easier for patients to find a radiologist perfectly suited to their care can only be a good thing; adding price transparency to boot would make such an approach very attractive. What’s not to like?

The Uberization of Medical Imaging

As it turns out, said Rubin, the picture is more complicated than it at first seems. He asserted that such an approach would enable the disaggregation of radiologists’ work. What might this look like? “One radiologist could be focused on just communicating with patients,” explained Rubin. “That’s their role: discussing what the test is, why it's appropriate, and answering their questions. We’d have another radiologist speaking exclusively with referring physicians — giving results, helping to contextualize those results, and advising on appropriate exam selection.” Further, said Rubin, a third radiologist could be present at the point of care to ensure a safe and high-quality exam.

This model in and of itself isn’t a bad concept, as long as each job function is assigned to the radiologist most ideally suited to perform it. In addition, Uberizing radiology makes it potentially easier for a group to assign one or more staff radiologists to be the “public” face of the practice, since they could be devoted to consulting with patients or referring providers. The technology provides ready access to expert consultation while allowing another pool of radiologists to interpret cases uninterrupted.

The biggest problem with this model, as I see it — and one duly noted by Rubin — is if many radiology practices were rolled up into a large national service with multiple redundant providers, then price could become the most important criteria by which radiologists are hired. Any equation based solely on cost that leaves the all-important metric of value out of consideration will not be to radiologists’ advantage, especially at a time when CMS is tying Medicare reimbursement dollars to the ability of physicians to demonstrate their value to patient care.

Expressing similar concerns, Rubin said, “If I were to project the extension of the Uber model into a nationalized service model, then in the absence of reliable metrics for determining what quality and value means, cost could become the prime differentiating factor for radiology services.” Alternatively, Rubin noted, “if the quality of subspecialty interpretation is a priority in a geography that is exclusively served by generalists, the system might support a premium for a subspecialty interpretation.”

My fear is that the fragmentation of radiologists’ services along the lines of a nationalized Uber model would inexorably get out of hand, stretching across the entire radiology marketplace. In this doomsday scenario, a referring clinician would call on one radiologist at Practice X in Peoria, Ill., to provide the read. Then, the same referring provider would tap another radiologist at Practice Y in Scottsdale, Ariz., to beam in via Facetime to be “present” for the point-of-care consultation. All of this disaggregation, in other words, would push radiologists further from direct contact with all of their clients: referring clinicians, hospital administrators, and, most importantly, patients.

At its worst, this approach could hasten the commoditization of the radiologist. If there was a way of mitigating the risk of radiologists becoming cogs in the wheel of a high-octane vehicle meant to deliver the lowest cost medical care at the fastest possible rate, I might be more optimistic. But innovation devoid of quality checks has a funny way of moving under its own momentum and quickly outpacing original intentions. Swapping out radiologists like spark plugs might become an unintended consequence of widespread and centralized Uberization of radiology.

Rubin agreed to an extent, saying, “The transactional nature of image interpretation makes it a strong candidate for Uberization.” While it is undoubtedly true that up until now image interpretation has, by and large, been seen by all parties as a transaction, radiologists must work to change this perception if they are to become value-added imaging consultants.

ACR’s Imaging 3.0™ initiative was established, in part, to alter this perception of image reading from transactional to consultative. It is easy for a hospital to replace a radiology practice that simply provides transactions; it is much harder for referring providers to advocate for the termination of a contract with radiologists with whom they have a relationship, who know what referrers need before they know it themselves.

Rubin concluded that this thought experiment provides an interesting exploration of different models for radiology’s future. “At its core as a cloud-based peer-to-peer communication and transaction facilitation tool, the outcome of Uberization’s use could either enhance or detract from the quality of radiology care, depending upon the setting in which it is applied. Technology is a purpose-blind enabler. It is up to us to embrace new capabilities and direct their application to build value.”

Post originally found: https://acrbulletin.org/62-sept2015/289-imaging-3-uberization