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Christensen EW, Chung Y, Rula EY, Parikh JR. Changes in the Radiology Practice Landscape and Indicators of Practice Consolidation From 2014 to 2023. AJR Am J Roentgenol 2024; 223:e2431357. [PMID: 38838234 DOI: 10.2214/ajr.24.31357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND. A range of economic and health policy incentives are leading to ongoing consolidation among payers, hospitals, and physician practices. OBJECTIVE. The purpose of the present study was to evaluate consolidation among radiologists' affiliated practices through 2023, analyze the impact of consolidation on such practices' specialty mix and size, and assess radiologists' new affiliations after prior practices cease. METHODS. CMS data from 2014 to 2023 were used to identify all radiologists nationally along with their affiliated practices. Based on the specialty mix of all affiliated physicians, practices were categorized as radiology only or multispecialty; multispecialty practices were further categorized as radiology majority, other specialty majority, or no majority specialty. Practices that ceased (i.e., became absent within CMS data) were identified. Temporal shifts were assessed to infer consolidation patterns. RESULTS. From 2014 to 2023, the number of radiologists enrolled in Medicare increased 17.3% (from 30,723 to 36,024), whereas the number of affiliated practices decreased 14.7% (from 5059 to 4313). The number of radiology-only, radiology-majority, other-specialty-majority, and no-majority-specialty practices changed by -31.8% (from 3104 to 2118), 10.9% (from 402 to 446), -5.7% (from 615 to 580), and 24.6% (from 938 to 1169), respectively. The number of practices with one to two, three to nine, 10-24, 25-49, 50-99, and 100 or more radiologists changed by -18.7% (from 2233 to 1815), -34.4% (from 1406 to 923), -25.2% (from 910 to 681), 33.2% (from 352 to 469), 121.6% (from 125 to 277), and 348.5% (from 33 to 148). A total of 3494 practices ceased, including 2281 radiology-only practices. Among 3854 radiologists whose only affiliation was a ceased radiology-only practice, their subsequent-year affiliation was a radiology-only practice in 54.3% and a multispecialty practice type in the remaining instances. CONCLUSION. An overall decrease in the number of radiology practices and concurrent growth in the number of radiologists was mirrored by shifts from small toward large practices and from radiology-only toward multispecialty practices, consistent with ongoing practice consolidation. Although determining the causes of consolidation was beyond this scope of this study, the shifts may relate to economic incentives and legislative changes favoring large multispecialty practices. CLINICAL IMPACT. The continued consolidation of radiologists into large multispecialty practices may facilitate subspecialization and greater negotiating power in payer contracting. However, radiologists may prefer smaller and/or radiology-only practices for reasons of autonomy and influence on practice structure.
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Affiliation(s)
- Eric W Christensen
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
- Health Services Management, University of Minnesota, St. Paul, MN
| | - YoonKyung Chung
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
| | - Elizabeth Y Rula
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
| | - Jay R Parikh
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Davis L, D'Souza S. Private equity in radiology - Why aren't we more concerned? Curr Probl Diagn Radiol 2024; 53:449-451. [PMID: 38604880 DOI: 10.1067/j.cpradiol.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
There has been recent scrutiny of private equity involvement in the healthcare market by federal and state governmental agencies who are concerned about the corporatization and financialization of healthcare in the United States. Data is emerging that patient costs increase, quality of healthcare decreases, physician autonomy decreases, and physician burnout and moral injury increases when corporate interests like private equity enter the medical market. Like other medical specialties, the field of radiology has been affected by corporatization and radiologists should understand how private equity interests may affect individual radiologists and the radiology workforce on a larger scale.
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Affiliation(s)
- Leah Davis
- Grand Traverse Radiologists, PC, 10850 Traverse Highway, Suite 1175, Traverse City, Michigan 49684, United States.
| | - Sharon D'Souza
- Tulsa Radiology Associates, 4111 S Darlington Ave Ste 700, Tulsa, OK 74135, United States
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3
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McGinty G. Developing Financial Acumen as a Breast Imaging Radiologist. JOURNAL OF BREAST IMAGING 2024:wbae035. [PMID: 38889270 DOI: 10.1093/jbi/wbae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 06/20/2024]
Abstract
The economics of health care and payment policy are complex and continually evolving. Breast imaging radiologists may not feel equipped to understand the financial aspect of their practice, but this is a critical competency from residency to senior leadership, especially for breast imaging radiologists. From conducting effective negotiations for new equipment as technology evolves to understanding how insurance benefit design affects patient access to care, breast imaging radiologists need to grasp the financial structures that underpins their practice. Fortunately, resources exist that are appropriate for each career stage, and this article directs the breast imaging radiologist to those resources.
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Affiliation(s)
- Geraldine McGinty
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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4
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Matsumoto AH, Dake MD. Implications of IR Being a Primary Specialty on the Professional Organizational Relationship between Interventional and Diagnostic Radiology. J Vasc Interv Radiol 2023; 34:2080-2084. [PMID: 38008543 DOI: 10.1016/j.jvir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/12/2023] [Indexed: 11/28/2023] Open
Abstract
The recent awarding of primary specialty status to interventional radiology (IR) invites a re-examination of the long-standing relationship between IR and diagnostic radiology (DR). In this new era, it is important to evaluate how the organizations that represent these 2 specialties can best contribute to strengthening a growth in collaborations and partnerships that will benefit their members and patients. Areas of organizational focus with the potential to enhance the future for both groups include combining efforts directed toward advocacy and government relations, developing practice models to create successful IR and DR working relationships, and providing more data to demonstrate the value of IR above and beyond the work relative value units and professional revenues that IR generates.
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Affiliation(s)
- Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia.
| | - Michael D Dake
- Department of Medical Imaging, Surgery and Medicine, University of Arizona Health Sciences, Tucson Campus, Health Sciences Innovation Building, Tucson, Arizona
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5
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Lee CI, Davis MA, Lexa FJ, Liao JM. JACR Health Policy Expert Panel: Private Equity Investment in Radiology. J Am Coll Radiol 2023; 20:940-942. [PMID: 37011830 DOI: 10.1016/j.jacr.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Christoph I Lee
- Director of the Northwest Screening and Cancer Outcomes Research Enterprise, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; and Deputy Editor, JACR.
| | - Melissa A Davis
- Vice Chair of Informatics, Department of Radiology, Yale University School of Medicine, New Haven, Connecticut. https://twitter.com/MelissaDavis29
| | - Frank J Lexa
- Department of Radiology, University of Pittsburgh School of Medicine and UPMC International, Pittsburgh, Pennsylvania; and Chief Medical Officer and Vice Chair, ACR Radiology Leadership Institute. https://twitter.com/fjlexa
| | - Joshua M Liao
- Director of the Value and Systems Science Lab and Associate Chair for Health Systems, Department of Medicine, University of Washington School of Medicine, Seattle, Washington. https://twitter.com/JoshuaLiaoMD
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6
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Patil SA, Vail DG, Cox JT, Chen E, Mruthyunjaya P, Tsai JC, Parikh R. Private equity in ophthalmology and optometry: a time series analysis from 2012 to 2021. Digit J Ophthalmol 2023; 29:1-8. [PMID: 37101563 PMCID: PMC10125728 DOI: 10.5693/djo.01.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Purpose To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States from 2012 to 2021. Methods In this cross-sectional time series, acquisition data from 10/21/2019 to 9/1/2021 and previously published data from 1/1/2012 to 10/20/2019 were analyzed. Acquisition data were compiled from 6 financial databases, 5 industry news outlets, and publicly available press releases. Linear regression models were used to compare rates of acquisition. Outcomes included number of total acquisitions, practice type, locations, provider details, and geographic footprint. Results A total of 245 practices associated with 614 clinical locations and 948 ophthalmologists or optometrists were acquired by 30 PE-backed platform companies between 10/21/2019 and 9/1/2021. Of 30 platform companies, 18 were new vis-à-vis our prior study. Of these acquisitions, 127 were comprehensive practices, 29 were retina practices, and 89 were optometry practices. From 2012 to 2021, monthly acquisitions increased by 0.947 acquisitions per year (P < 0.001*). Texas, Florida, Michigan, and New Jersey were the states with the greatest number of PE acquisitions, with 55, 48, 29, and 28 clinic acquisitions, respectively. Average monthly PE acquisitions were 5.71 per month from 1/1/2019 to 2/29/2020 (pre-COVID), 5.30 per month from 3/1/2020 to 12/31/2020 (COVID pre-vaccine [P = 0.81]), and 8.78 per month from 1/1/2021 to 9/1/2021 (COVID post-vaccine [P = 0.20]). Conclusions PE acquisitions increased during the period 2012-2021 as companies continue to utilize regionally focused strategies for acquisitions.
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Affiliation(s)
- Sachi A. Patil
- Department of Ophthalmology, New York University, Grossman School of Medicine, New York, New York
| | - Daniel G. Vail
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Jacob T. Cox
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Evan Chen
- Department of Ophthalmology, University of California, San Francisco, California
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - James C. Tsai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Ravi Parikh
- Department of Ophthalmology, New York University, Grossman School of Medicine, New York, New York
- Manhattan Retina and Eye Consultants, New York, New York
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7
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Morales Santos Á, Del Cura Rodríguez JL, Antúnez Larrañaga N. Teleradiology: good practice guide. RADIOLOGIA 2023; 65:133-148. [PMID: 37059579 DOI: 10.1016/j.rxeng.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/12/2022] [Indexed: 04/16/2023]
Abstract
Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards.
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Affiliation(s)
- Á Morales Santos
- Servicio de Radiología, Hospital Universitario Donostia, San Sebastián, Spain.
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8
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Telerradiología: guía de buenas prácticas. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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9
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Kim YH, Bhandarkar AR, Adeleye O, Zhu A, Bydon M, Vidal NY. Socioeconomic predictors of cost and length of stay for erythroderma: a cross-sectional analysis of the national inpatient sample. Arch Dermatol Res 2022; 315:869-877. [PMID: 36367570 DOI: 10.1007/s00403-022-02463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Erythroderma is an uncommon but serious dermatologic disorder that often requires hospitalization for diagnosis and treatment. However, little is known about predictors influencing cost and patient outcomes. The present study sought to characterize the sociodemographic factors that predict patient outcomes and hospital cost. Data were obtained from the 2016-2018 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality for patients of any age with a primary or secondary diagnosis of exfoliative dermatitis. Regression analyses were performed to find predictors for hospital costs and patient outcomes, represented by the length of stay (LOS). Univariate analysis of LOS revealed urban teaching hospitals were associated with prolonged LOS (p = 0.023). Univariate analysis of hospital cost yielded the following factors associated with increased hospital cost: Black and Asian patients (p = .045), urban teaching hospitals (p = .035), and northeast or south geographic location (p = .004). Multivariable regression analysis revealed prolonged LOS was associated with female sex (p = .043) and large bed capacity (p = .044) while shorter LOS was associated with increased age (p = .025); lower hospital costs were associated with private-owned hospitals - (p = .025). In patients diagnosed with erythroderma, there appear to be racial, economic, and geographic disparities for patients that lead to greater hospital costs and longer LOS.
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Affiliation(s)
- Yong-Hun Kim
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | | | - Agnes Zhu
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Nahid Y Vidal
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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10
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Brill D, Luo S, Sridhar J, Williams BK. Private equity in ophthalmology: lessons from other specialties. Curr Opin Ophthalmol 2022; 33:352-361. [PMID: 35916564 DOI: 10.1097/icu.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In the absence of long-term data of the effects of private equity in ophthalmology, this article reviews the role of private equity in other medical specialties as a guide to the future for ophthalmology. RECENT FINDINGS Across an array of medical specialties, including anesthesiology, dermatology, emergency medicine, ophthalmology/optometry, radiology, and urology, medical practices are being consolidated into a few larger platform groups. Although there has been a short-term financial success for both private equity firms and senior medical practice partners, there exists broad skepticism from peer-reviewed publications and the national media. SUMMARY Although the impact of private equity on ophthalmology is largely speculative, ophthalmology may follow some of the trends observed in other medical specialties. These trends include increased volume of services, increased profits, improved payer mix, increased payment per patient visit, increased use of midlevel practitioners, decreased physician autonomy, and decreased physician salaries.
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Affiliation(s)
- Daniel Brill
- Department of Ophthalmology, University of Cincinnati College of Medicine
- Cincinnati Eye Institute, Cincinnati, Ohio, USA
| | - Shiming Luo
- Department of Ophthalmology, University of Cincinnati College of Medicine
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Basil K Williams
- Department of Ophthalmology, University of Cincinnati College of Medicine
- Cincinnati Eye Institute, Cincinnati, Ohio, USA
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11
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Khan MA. Private equity acquisitions: physician considerations at different stages of career. Curr Opin Ophthalmol 2022; 33:381-384. [PMID: 35916567 DOI: 10.1097/icu.0000000000000872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To assess the impact of private equity acquisitions on physician career considerations, with particular attention to stage of career. RECENT FINDINGS Recent studies have demonstrated a clear increase in private equity acquisitions in ophthalmology, particularly in retina-oriented practices. Survey-related publications of recent fellow graduates may provide insights regarding considerations of early career ophthalmologists, whereas commentaries from senior ophthalmologists offer insights to considerations of late career physicians. To date, no published evidence exists regarding the differential financial and/or professional effects of private equity acquisitions on ophthalmologists with regards to career stage. Such effects may differ on the specific structure, nature, and terms of the private equity acquisition. SUMMARY Private equity acquisitions in ophthalmology may have several short-term, mid-term, and long-term effects on physicians over a variety of financial and career considerations. As such, there may be a differential effect of private equity acquisitions on early, mid, and late career physicians. Future outcome-related data will be necessary to fully understand the impact of private equity acquisitions on physicians both professionally and with regards to clinical care.
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12
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Patel V, Nijm LM. Contractual considerations in the private equity era. Curr Opin Ophthalmol 2022; 33:389-393. [PMID: 35838254 DOI: 10.1097/icu.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Private equity (PE) has grown rapidly in medicine. The reintroduction of PE in ophthalmology has necessitated a greater understanding of the potential contractual relationships with PE firms from both a practice owner and an employee physician perspective. There are contractual obligations that need to be met as PE agreements are designed to ensure clear investment patterns and abide by legal mandates. A practice owner entering into a PE contract needs to consider how the practice is being valued, what their obligations are to the PE entity after the sale has been completed to attain full compensation and understand their new role at the practice. On the other hand, employee ophthalmologists must carefully evaluate the compensation package being offered in terms of the type of equity, vesting of shares, obligations to the PE firm under the agreement such as a noncompete clause, and what occurs under a subsequent sale of the practice. Overall, contractual considerations in the private equity era need to be carefully evaluated in order to ensure the agreement is in the best interest for the clinician, practice, and their patients.
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Affiliation(s)
- Veshesh Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Lisa M Nijm
- Warrenville EyeCare & LASIK, Warrenville
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
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13
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Perry H, Narayan A, Phillips J, Sheth MM, Slanetz PJ. Tips for Successful Career Transitions in Breast Imaging. JOURNAL OF BREAST IMAGING 2022; 4:423-429. [PMID: 38416984 DOI: 10.1093/jbi/wbac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 03/01/2024]
Abstract
Whether beginning a new career in breast imaging or switching into a different breast imaging practice for personal or professional advancement, a leadership opportunity, a need to relocate geographically, or simply a better opportunity, it is critical to transition between positions as smoothly as possible. Thoroughly reflecting on your career priorities and goals is essential prior to undertaking any career transition. Once the decision has been made to move to a new position, it is imperative to learn about the dynamics of the new practice and practice environment. Here, we provide suggestions on how to hit the ground running when joining a new breast imaging practice.
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Affiliation(s)
- Hannah Perry
- University of Vermont Medical Center and Larner College of Medicine at the University of Vermont, Department of Radiology, Burlington, VT, USA
| | - Anand Narayan
- University of Wisconsin-Madison, Department of Radiology, Madison, WI, USA
| | - Jordana Phillips
- Boston University Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
| | - Monica M Sheth
- NYU Langone-Long Island Hospital and NYU Grossman School of Medicine, Department of Radiology, Mineola, NY, USA
| | - Priscilla J Slanetz
- Boston University Medical Center and Boston University School of Medicine, Department of Radiology, Boston, MA, USA
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14
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Santavicca S, Hughes DR, Rosenkrantz AB, Rubin E, Duszak R. Radiology Practices Employing Nurse Practitioners and Physician Assistants: Characteristics and Trends From 2017 Through 2019. J Am Coll Radiol 2022; 19:746-753. [DOI: 10.1016/j.jacr.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 01/21/2023]
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15
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Clinician-Scientists: Can They Survive in the Modern Era? J Am Coll Radiol 2021; 18:192-197. [PMID: 33413899 DOI: 10.1016/j.jacr.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022]
Abstract
Clinician-scientists are commonly characterized as health care professionals who are proficient in both research and clinical practice. Their dual expertise positions them to play a vital role in translating research outcomes to clinical practice. However, economic changes in the past few decades are threatening their very survival. The purposes of this article are to review some of the economic forces that pose the greatest risks to clinician-scientists in the modern era and to glean lessons from the business world in overcoming these challenges. Health care consolidation and decreasing reimbursements are putting increasing financial pressure on academic institutions, leaving them more inclined to cut back on departmental research support. Innovative companies commit a certain percentage of their revenue to research and discovery. Academic institutions should similarly view their research budget as research and discovery that will sustain the future growth of radiology. They should quantify and define expectations for academic productivity, focus on return on investment, and bolster the infrastructure to foster commercial partnerships that can provide additional revenue to support the research mission. Success in academics does not occur by accident. It requires more than individual talent and hard work. It also requires institutional leaders who are committed to developing future academic leaders and supporting innovation.
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16
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DeCamp M, Snyder Sulmasy L. Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices: A Policy Paper From the American College of Physicians. Ann Intern Med 2021; 174:844-851. [PMID: 33721520 DOI: 10.7326/m20-7093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.
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Affiliation(s)
- Matthew DeCamp
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.D.)
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Santavicca S, Duszak R, Nicola GN, Golding LP, Rosenkrantz AB, Wernz C, Hughes DR. Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations. J Am Coll Radiol 2021; 18:1332-1341. [PMID: 34022135 DOI: 10.1016/j.jacr.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). METHODS Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time. RESULTS Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, and the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 versus 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% versus 38.5%), and ACOs with radiologists had a higher rate of specialist representation (56.0% versus 33.7%). Beneficiary age, race, and sex demographics were similar among radiologist-participating versus nonparticipating ACOs. CONCLUSIONS In recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.
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Affiliation(s)
- Stefan Santavicca
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia.
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group, River Edge, New Jersey
| | - Lauren Parks Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Andrew B Rosenkrantz
- Professor of Radiology and Urology, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Christian Wernz
- Department of Data Science, University of Virginia Health System, Charlottesville, Virginia
| | - Danny R Hughes
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; Professor, School of Economics, Georgia Institute of Technology, Director, Health Economics and Analytics Lab (HEAL), Atlanta, Georgia
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Ali K, Lohnes J, Moriarity A. Best Practices and Critical Factors in a Successful Private Practice. J Am Coll Radiol 2021; 18:777-782. [PMID: 33957134 DOI: 10.1016/j.jacr.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Independent private practice has historically been the predominant practice model in radiology. In the last two decades, this model has faced increasing pressures on both a micro and macro level, which threatens its existence. In the current health care environment, how does a practice stay independent? The authors address some of the critical factors needed for a successful practice. These factors are derived from the collective experience of the authors who are in private practice as well as best practices described in the literature. Strengths that already exist in the practice, opportunities that can be capitalized on, and looming or existing threats to the independence of a private group are discussed. Recommendations are provided on how to optimize an individual practice and reduce the risk of alternative practice penetration.
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Affiliation(s)
- Kamran Ali
- President, Wichita Radiological Group, Wichita, Kansas
| | - John Lohnes
- CEO, Wichita Radiological Group, Wichita, Kansas
| | - Andrew Moriarity
- Michigan State University College of Human Medicine Division of Radiology and Biomedical Imaging. Grand Rapids, Michigan
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19
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Santavicca S, Hughes DR, Fleishon HB, Lexa F, Rubin E, Rosenkrantz AB, Duszak R. Radiologist-Practice Separation: Recent Trends and Characteristics. J Am Coll Radiol 2021; 18:580-589. [PMID: 33197406 DOI: 10.1016/j.jacr.2020.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess recent trends and characteristics in radiologist-practice separation across the United States. METHODS Using the Medicare Physician Compare and Medicare Physician and Other Supplier Public Use File data sets, we linked all radiologists to associated group practices annually between 2014 and 2018 and assessed radiologist-practice separation over a variety of physician and group characteristics. Multivariate logistic regression modeling was used to estimate the likelihood of radiologist-practice separation. RESULTS Of 25,228 unique radiologists associated with 4,381 unique group practices, 41.1% separated from at least one group practice between 2014 and 2018, and annual separation rates increased 38.4% over time (13.8% from 2014 to 2015 to 19.2% from 2017 to 2018). Radiologist-practice separation rates ranged from 57.4% in Utah to 26.3% in Virginia. Separation rates were 42.8% for general radiologists versus 38.2% for subspecialty radiologists. Among subspecialists, separation rates ranged from 43.0% for breast imagers to 33.5% for cardiothoracic radiologists. Early career status (odds ratio [OR] = 1.286) and late (OR = 1.554) career status were both independent positive predictors of radiologist-practice separation (both P < .001). Larger practice size (OR = 0.795), radiology-only (versus multispecialty) group (OR = 0.468), academic (versus nonacademic) practice (OR = 0.709), and abdominal (OR = 0.820), musculoskeletal (OR = 0.659), and neuroradiology (OR = 0.895) subspecialization were independent negative predictors (all P < .05). CONCLUSIONS With over 40% of radiologists separating from at least one practice in recent years, the US radiologist workforce is highly and increasingly mobile. Because reasons for separation (eg, resignation, practice acquisition) cannot be assessed using administrative data, further attention is warranted given the manifold financial, operational, and patient care implications.
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Affiliation(s)
- Stefan Santavicca
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia.
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; Professor, School of Economics and Director, Health Economics and Analytics Lab (HEAL) Georgia Institute of Technology, Atlanta, Georgia
| | - Howard B Fleishon
- Chair, ACR Board of Chancellors, American College of Radiology, Reston, Virginia; Associate Professor, Department of Radiology and Medical Imaging, Emory University, Atlanta, Georgia and Chief of Radiology Services, Emory Johns Creek Hospital, Johns Creek, Georgia
| | - Frank Lexa
- Professor and Vice Chair-Faculty Affairs, Department of Radiology, University of Pittsburgh and UPMC International. Chief Medical Officer, The Radiology Leadership Institute and Chair of the Commission on Leadership and Practice Development of the American College of Radiology
| | - Eric Rubin
- Director, CT Division, Southeast Radiology Limited, Ridley Park, Pennsylvania
| | - Andrew B Rosenkrantz
- Professor of Radiology and Urology, Director of Prostate Imaging, Director of Health Policy, and Section Chief of Abdominal Imaging, Department of Radiology, NYU Grossman School of Medicine, and NYU Langone Health, New York, New York
| | - Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia
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20
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Muroff LR. Will Venture Capital-Supported National Entities Change Radiology From a Specialty of Independent Owners to Employed Shift Workers? J Am Coll Radiol 2021; 18:792-794. [PMID: 33676916 DOI: 10.1016/j.jacr.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
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21
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Sharpe RE, Kuszyk BS, Mossa-Basha M. Special Report of the RSNA COVID-19 Task Force: The Short- and Long-term Financial Impact of the COVID-19 Pandemic on Private Radiology Practices. Radiology 2021; 298:E11-E18. [PMID: 32677874 PMCID: PMC7370355 DOI: 10.1148/radiol.2020202517] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread disruption to the global economy, including demand for imaging services. The resulting reduction in demand for imaging services had an abrupt and substantial impact on private radiology practices, which are heavily dependent on examination volumes for practice revenues. The goal of this report is to describe the specific experiences of radiologists working in various types of private radiology practices during the initial peak of the COVID-19 pandemic. Herein, the authors describe factors determining the impact of the pandemic on private practices, the challenges these practices faced, the cost levers leaders adjusted, and the government subsidies sought. In addition, the authors describe adjustments practices are making to their mid- and long-term strategic plans to pivot for long-term success while managing the COVID-19 pandemic. Private practices have crafted tiered strategies to respond to the impact of the pandemic by pulling various cost levers to adjust service availability, staffing, compensation, benefits, time off, and expense reductions. In addition, they have sought additional revenues, within the boundaries of their practice, to mitigate ongoing financial losses. The longer term impact of the pandemic will alter existing practices, making some of them more likely than others to succeed in the years ahead. This report synthesizes the collective experience of private-practice radiologists shared with members of the Radiological Society of North America COVID-19 Task Force, including discussions with colleagues and leaders of private-practice radiology groups from across the United States.
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Affiliation(s)
- Richard E Sharpe
- From the Department of Radiology, Mayo Clinic Arizona, 5881 E Mayo Blvd, Phoenix, AZ 85054 (R.E.S.); Eastern Radiologists, Greenville, NC (B.S.K.); and Department of Radiology, University of Washington, Sammamish, WA (M.M.B.). The full list of RSNA COVID-19 Task Force members is listed at the end of the article
| | - Brian S Kuszyk
- From the Department of Radiology, Mayo Clinic Arizona, 5881 E Mayo Blvd, Phoenix, AZ 85054 (R.E.S.); Eastern Radiologists, Greenville, NC (B.S.K.); and Department of Radiology, University of Washington, Sammamish, WA (M.M.B.). The full list of RSNA COVID-19 Task Force members is listed at the end of the article
| | - Mahmud Mossa-Basha
- From the Department of Radiology, Mayo Clinic Arizona, 5881 E Mayo Blvd, Phoenix, AZ 85054 (R.E.S.); Eastern Radiologists, Greenville, NC (B.S.K.); and Department of Radiology, University of Washington, Sammamish, WA (M.M.B.). The full list of RSNA COVID-19 Task Force members is listed at the end of the article
| | - For the RSNA COVID-19 Task Force
- From the Department of Radiology, Mayo Clinic Arizona, 5881 E Mayo Blvd, Phoenix, AZ 85054 (R.E.S.); Eastern Radiologists, Greenville, NC (B.S.K.); and Department of Radiology, University of Washington, Sammamish, WA (M.M.B.). The full list of RSNA COVID-19 Task Force members is listed at the end of the article
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22
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Bruch JD, Gondi S, Song Z. Changes in Hospital Income, Use, and Quality Associated With Private Equity Acquisition. JAMA Intern Med 2020; 180:1428-1435. [PMID: 32833006 PMCID: PMC7445629 DOI: 10.1001/jamainternmed.2020.3552] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Rigorous evidence describing the relationship between private equity acquisition and changes in hospital spending and quality is currently lacking. OBJECTIVE To examine changes in hospital income, use, and quality measures that may be associated with private equity acquisition. DESIGN, SETTING, AND PARTICIPANTS This cohort study identified 204 hospitals acquired by private equity firms from 2005 to 2017 and 532 matched hospitals not acquired by private equity. Using a difference-in-differences design, this study evaluated changes in net income, charges, charge to cost ratios, case mix index (a measure of reported illness burden), share of discharges for patients with Medicare or Medicaid coverage, discharges per year, and aggregate hospital quality measures associated with private equity acquisition through 3 years after acquisition, adjusted for case mix, hospital beds, calendar year, and adjustment for multiple hypothesis testing. In subgroup analyses, changes in outcomes for private equity-owned Hospital Corporation of America (HCA) hospitals and non-HCA hospitals relative to matched controls were assessed. PRIMARY OUTCOMES AND MEASURES Eight hospital income and use measures and 3 aggregate hospital quality measures were examined. RESULTS Relative to 532 control hospitals, the 204 private equity-acquired hospitals showed a mean increase of $2 302 391 (95% CI, $956 660-$3 648 123; P = .009) in annual net income, an increase of $407 (95% CI, $296-$518; P < .001) in total charge per inpatient day, an increase of 0.61 (95% CI, 0.48-0.73; P < .001) in emergency department charge to cost ratio, an increase of 0.31 (95% CI, 0.26-0.37; P < .001) in total charge to cost ratio, an increase of 0.02 (95% CI, 0.01-0.02; P = .007) in case mix index, and a decrease of 0.96% (95% CI, 0.46%-1.45%; P = .002) in share of Medicare discharges. Medicaid's share of discharges (-0.16%; 95% CI, -0.86% to 0.53%; P > .99) and total hospital discharges (98; 95% CI, -54 to 250; P > .99) did not change differentially in a statistically significant manner. The aggregate quality score for acute myocardial infarction increased by 3.3% (95% CI, 1.6%-5.0%; P = .002), and the aggregate score for pneumonia increased by 2.9% (95% CI, 1.8%-3.9%; P < .001) in private equity-acquired hospitals relative to controls. The aggregate score for heart failure (1.3%; 95% CI, -0.2% to 2.7%; P = .92) did not differentially change in a statistically significant manner. In subgroup analyses, HCA hospitals showed similar findings to the entire sample. Among non-HCA hospitals, the only statistically significant relative changes were the increase in the emergency department charge to cost ratio (0.30; 95% CI, 0.12-0.48; P = .02) and the decrease in Medicare's share (-1.15%; 95% CI, -1.88% to -0.43%; P = .02). Non-HCA hospitals showed a decrease in the aggregate heart failure score (-3.3%; 95% CI, -5.3% to -1.3%; P = .01) and no statistically significant changes in the aggregate score for acute myocardial infarction (2.4%; 95% CI, -0.7% to 5.4%; P > .99) or pneumonia (0.2%; 95% CI, -1.4% to 1.7%; P > .99). CONCLUSIONS AND RELEVANCE Hospitals acquired by private equity were associated with larger increases in net income, charges, charge to cost ratios, and case mix index as well as with improvement in some quality measures after acquisition relative to nonacquired controls. Heterogeneity in some findings was observed between HCA and non-HCA hospitals.
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Affiliation(s)
- Joseph D Bruch
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Suhas Gondi
- Harvard Medical School, Boston, Massachusetts
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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23
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Duszak R, Maze J, Sessa C, Fleishon HB, Golding LP, Nicola GN, Hughes DR. Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work. J Am Coll Radiol 2020; 17:1453-1459. [PMID: 32682745 PMCID: PMC7332916 DOI: 10.1016/j.jacr.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines. METHODS Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed. RESULTS Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%). CONCLUSIONS Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.
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Affiliation(s)
- Richard Duszak
- Professor and Vice Chair of Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia.
| | - Jeff Maze
- Founder and CEO of Quinsite, LLC, Chapel Hill, North Carolina
| | - Candice Sessa
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Emory Healthcare, Atlanta, Georgia; Division Director, Community Radiology, Atlanta, Georgia
| | - Lauren P Golding
- Executive Committee Chair, and Clinical Operations Chair, Triad Radiology Associates, Winston Salem, North Carolina
| | - Gregory N Nicola
- Finance Chair and Board Member at Hackensack Meridian Health Partners Clinically Integrated Network; Executive leadership position at Hackensack Radiology Group PA, River Edge, New Jersey
| | - Danny R Hughes
- Executive Director, Harvey L. Neiman Health Policy Institute, Washington, DC; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
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24
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Zabel AOJ, Leschka S, Wildermuth S, Hodler J, Dietrich TJ. Subspecialized radiological reporting reduces radiology report turnaround time. Insights Imaging 2020; 11:114. [PMID: 33123830 PMCID: PMC7596149 DOI: 10.1186/s13244-020-00917-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives The objective of this study was to compare the radiology report turnaround time (RTAT) between decentralized/modality-based and centralized/subspecialized radiological reporting at a multi-center radiology enterprise. Methods RTAT values for MRI, CT, and conventional radiography were compared between decentralized/modality-based (04 September 2017–22 December 2017) and centralized/subspecialized radiology (03 September 2018–21 December 2018) reporting grouped into three subspecializations (body radiology, musculoskeletal radiology, and neuroradiology) at eleven sites of a multi-center radiology enterprise. For the objective of this investigation, hospitals were defined as major and minor hospitals. The Mann-Whitney U test served for statistical analyses. Results Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology resulted overall in a significant decrease of the RTAT: from 82 to 77 min for the first signature (p < 0.001), and 119 to 107 min and 295 to 238 min for the second signature (p < 0.001). Subgroup analyses demonstrate a significant decrease of the RTAT for MRI reports (e.g., second signature RTAT, 1051 to 401 min; p < 0.001) and conventional radiographs (e. g., second signature RTAT, 278 to 171 min; p < 0.001). The RTAT at major hospitals decreased from 288 to 245 min (second signature; p < 0.001) while the corresponding RTAT of minor hospitals decreased more remarkably, from 300 to 198 min (p < 0.001). However, the results were heterogenous; in some analyses, the RTAT even increased. The effect size analyses represent small effects. Conclusions Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology was associated with a significant decreased RTAT. Specifically, the RTAT for MRI reports and conventional radiographs was significantly reduced. A pronounced RTAT decrease was observed at minor hospitals.
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Affiliation(s)
- Andreas Otto Josef Zabel
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Juerg Hodler
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.,Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, CH, Switzerland
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
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25
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Munawar K, Sugi MD, Prabhu V. Radiology in the News: A Content Analysis of Radiology-Related Information Retrieved From Google Alerts. Curr Probl Diagn Radiol 2020; 50:825-830. [PMID: 33041161 PMCID: PMC7544702 DOI: 10.1067/j.cpradiol.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Google Alerts highlighted a diverse set of topics present in online media. Most links were directly to non-radiology lay press, but <1% of links over the 6-month period sent the user directly to a primary peer-reviewed medical journal article. The most common topics were market trends, promotional, COVID-19, and artificial intelligence.
Introduction Radiology topics receive substantial online media attention, with prior studies focusing on social media platform coverage. We used Google Alerts, a content change detection and notification service, to prospectively analyze new radiology-related content appearing on the internet. Materials and Methods An automated notification was created on Google Alerts for the search term “radiology,” sending the user emails with up to 3 new links daily. All links from November 2019 through April 2020 were assessed by 2 of 3 independent raters using a coding system to classify the content source and primary topic of discussion. The top 5 primary topics were retrospectively evaluated to identify prevalent subcategories. Content viewing restrictions were documented. Results 526 links were accessed. The majority (68%) of links were created by non-radiology lay press, followed by radiology-related lay press (28%), university-based publications (2%), and professional society websites (2%). The primary topic of these links most frequently related to market trends (28%), promotional material (20%), COVID-19 (13%), artificial intelligence (8%), and new technology or equipment (5%). 15% of links discussed a topic sourced from another article, such as a peer-reviewed journal, though only 2 linked directly to the journal itself. 8% of links had content viewing restrictions. Conclusion New radiology content was largely disseminated via non-radiology news sources; radiologists should therefore ensure their research and viewpoints are presented in these outlets. Google Alerts may be a useful tool to stay abreast of the most current public radiology subject matters, especially during these times of social isolation and rapidly evolving clinical practice.
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Affiliation(s)
- Kamran Munawar
- NYU Langone Health, Department of Radiology, New York, NY.
| | - Mark D Sugi
- University of California, San Francisco, Department of Radiology, San Francisco, CA. https://twitter.com/markdsugi
| | - Vinay Prabhu
- NYU Langone Health, Department of Radiology, New York, NY. https://twitter.com/yaniv34
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26
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Lexa FJ, Lexa FJ. Private Equity-Backed Hospital Investments and the Impact of the Coronavirus Disease 2019 (COVID-19) Epidemic. J Am Coll Radiol 2020; 17:1049-1052. [PMID: 32473895 PMCID: PMC7250758 DOI: 10.1016/j.jacr.2020.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Frank J Lexa
- Radiology Leadership Institute and Commission on Leadership and Practice Development, ACR, Reston, Virginia.
| | - Frank James Lexa
- Cornell University, School of Industrial and Labor Relations, Ithaca, New York
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27
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Rosen MP, Norbash A, Kruskal J, Meltzer CC, Yee J, Thrall J. Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Clinical Radiology. J Am Coll Radiol 2020; 17:1096-1100. [PMID: 32721410 PMCID: PMC7346805 DOI: 10.1016/j.jacr.2020.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the "usual scope" of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.
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Affiliation(s)
- Max P Rosen
- Chair of Radiology, Department of Radiology, UMass Memorial Medical Center & UMass Medical School, Worcester, Massachusetts.
| | - Alexander Norbash
- Chair of Radiology, UCSD School of Medicine and UC San Diego Health, San Diego, California
| | - Jonathan Kruskal
- Chair of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carolyn C Meltzer
- Chair of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Judy Yee
- Chair of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - James Thrall
- Massachusetts General Hospital, Boston, Massachusetts
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28
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Norbash AM, Moore AV, Recht MP, Brink JA, Hess CP, Won JJ, Jain S, Sun X, Brown M, Enzmann D. Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic: Adaptations, Risks, and Lessons Learned. J Am Coll Radiol 2020; 17:1086-1095. [PMID: 32717183 PMCID: PMC7346772 DOI: 10.1016/j.jacr.2020.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned. Methods Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition. Results Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging. Conclusion Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.
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Affiliation(s)
- Alexander M Norbash
- Chair, Department of Radiology, University of California, San Diego, California.
| | - Arl Van Moore
- Chair, Chief Executive Officer, Strategic Radiology, LLC, Palmetto, Florida
| | - Michael P Recht
- Chair, Department of Radiology, New York University, Grossman School of Medicine, New York, New York
| | - James A Brink
- Chair, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Hess
- Chair, Department of Radiology, University of California, San Francisco, California
| | - Jay J Won
- University of California, Los Angeles, California
| | - Sonia Jain
- University of California, San Diego, California
| | | | - Manuel Brown
- Chair, Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Dieter Enzmann
- Chair, Department of Radiology, University of California, Los Angeles, California
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29
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Ortiz DA. Disclosure of Conflict of Interest. J Am Coll Radiol 2020; 17:831. [DOI: 10.1016/j.jacr.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 10/23/2022]
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30
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Carlos RC. Editorial Response. J Am Coll Radiol 2020; 17:832. [DOI: 10.1016/j.jacr.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022]
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Abstract
The COVID-19 pandemic will have a profound impact on Radiology practices across the country. Policy measures adopted to slow the transmission of disease are decreasing the demand for imaging independent of COVID-19. Hospital preparations to expand crisis capacity are further diminishing the amount of appropriate medical imaging that can be safely performed. While economic recessions generally tend to result in decreased health care expenditures, radiology groups have never experienced an economic shock that is simultaneously exacerbated by the need to restrict the availability of imaging. Outpatient heavy practices will feel the biggest impact of these changes, but all imaging volumes will decrease. Anecdotal experience suggests that radiology practices should anticipate 50%-70% decreases in imaging volume that will last a minimum of 3-4 months, depending on the location of practice and the severity of the COVID-19 pandemic in each region. The CARES Act provides multiple means of direct and indirect aid to healthcare providers and small businesses. The final allocation of this funding is not yet clear, and it is likely that additional congressional action will be necessary to stabilize health care markets. Administrators and practice leaders need to be proactive with practice modifications and financial maneuvers that can position them to emerge from this pandemic in the most viable economic position. It is possible that this crisis will have lasting effects on the structure of the radiology field.
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Affiliation(s)
- Joseph J Cavallo
- From the Department of Radiology, Yale New Haven Hospital, 330 Cedar St, TE 2-214, New Haven, CT 06520 (J.J.C., H.P.F.); Yale School of Management, New Haven, Conn (J.J.C., H.P.F.); and Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Howard P Forman
- From the Department of Radiology, Yale New Haven Hospital, 330 Cedar St, TE 2-214, New Haven, CT 06520 (J.J.C., H.P.F.); Yale School of Management, New Haven, Conn (J.J.C., H.P.F.); and Yale School of Public Health, New Haven, Conn (H.P.F.)
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Parke DW. Corporatization in Ophthalmology. Ophthalmology 2020; 127:456-457. [DOI: 10.1016/j.ophtha.2020.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/25/2022] Open
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Vijayasarathi A. Unionizing Radiology: A Potential Response to Increasing Corporatization. J Am Coll Radiol 2020; 17:365-367. [DOI: 10.1016/j.jacr.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 10/24/2022]
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Early-Career Radiologists’ Perceptions of National Corporations in Radiology. J Am Coll Radiol 2020; 17:349-354. [DOI: 10.1016/j.jacr.2019.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
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Heller RE, Hawkins CM. Separating Fact From Fiction: Understanding Evolving Radiology Practice Models. J Am Coll Radiol 2020; 17:337-339. [DOI: 10.1016/j.jacr.2019.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/24/2022]
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Hardy SM, Lexa FJ, Bruno MA. Potential Implications of Current Corporate Strategy for the US Radiology Industry. J Am Coll Radiol 2020; 17:361-364. [PMID: 32139027 DOI: 10.1016/j.jacr.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Seth M Hardy
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Frank J Lexa
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
| | - Michael A Bruno
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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