Do You Really Want This Smaller Future?

April 1, 2013

In a very well written article by Cat Vasko, editor of Medical Imaging Review, Accountable Radiology: Eliminating Sleepless Nights, Vasko covers the comments of James Reinertsen, M.D. of the Reinertsen Group, a consultant, at a 2012 American College of Radiology conference.

In a nutshell, Reinertsen states that radiologists should reconcile themselves to lower incomes and simply focus on quality.

Although all should laud Dr. Reinertsen’s comments about the need to focus on quality of care, he does a wonderful job of explaining the future of radiology, indeed, of all physicians, from the hospital and government perspective:

— You should see world as half empty.

— You will work for less.

— Suck it up, no one in the real world cares if your income drops 30%, you’re still among the 1%.

Just as obviously, any radiologist who wants to be successful should see that this Reinertsen fellow’s advice to settle for less is worthless, that is, unless you like the future he has planned for you.

The reason why fixed salary systems lauded by this guy drive cooperation between specialists and reduce “overuse” is that they create a perverse incentive not to work. Visit your local department of motor vehicles office and see how it plays out.

In my work with radiologists and other physician groups across the country, I often encounter this same defeatist attitude from physicians, and hear the same advice to get used to the new world of less pay from hospital administrators and their industry consultants.

Instead, assuming that your specialty is in for a 30% reduction in volume (which does not necessarily mean a 30% reduction in reimbursement), strategic group leaders need to think how to adjust staffing and how to expand their business to counter negative pressure on overall compensation.

Reinertsen is quoted as saying that the ACO is about accountability to patients. It’s not: It’s about accountability to the accountant types who will judge your quality based upon what’s easy to measure, engage in past-based cost accounting, and award you your little slice of their pie.

Smarter medical groups leaders will instead seek to make their group’s pie bigger.

It’s time to get baking.

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