Dr. Vivian S. Lee confessed to a crowded RSNA auditorium that she does not know what is going to happen to U.S. health care in the aftermath of November's shocking presidential election outcome. Adding that, “If anyone does, please let me know!"

But in the meantime, the senior vice president of the University of Utah Health Sciences, CEO of University of Utah Healthcare, and dean of the University of Utah School of Medicine, stipulated that the model of a value-driven health care market must be advanced, and made the case that radiologists can take a leading role in doing so.

Based on her broad-range experience as a radiologist and executive, Lee’s oration on “Driving Value through Imaging” first acknowledged that health care in America is in a state of crisis.
“The cost of health care in the past 50 years has risen more than 800 percent,” she showed, “almost five times the rise in the gross domestic product and over 50 times the increase in wages for the average American.” Lee described this increase as "simply unsustainable,” adding that it is exacerbated by the fact that quality measures in the U.S., per capita, including infant mortality rates, are poorer than most Organization for Economic Cooperation and Development (OECD) nations.

Recent policies to address this crisis have been based on pay-for-performance, but this model may have reached a “tipping point” and definitions must be recalibrated. Based on her work at the University of Utah Healthcare, Lee provided examples of metrics and methods necessary to successfully convert to value-driven organizations.

Essential is elucidating a basic formula: how can quality and service be combined at reasonable costs? Approaches to answering this involve “transparency in patient satisfaction” studies, deep metric analysis of costs per every service, and engaging faculty and staff with the resultant data in order to develop leaner value-driven strategies, according to Lee.

Within this broader process, she contended, radiologists cannot remain complacent. While demonstrating that radiology has been the domain of some of the most innovative advances in modern medicine, including MR and CT scanning, there has been a significant drop-off in reimbursements, the job market, and even medical students choosing to study radiology.

Questions about the use of “unnecessary medical tests” have rightly or wrongly targeted imaging, but Lee asserts that this is merely a symptom of more general issues in the health care market. “I think, without a doubt, those of us who have trained in the last 20 or 30 years will say we have had an enormous impact on the field of medicine,” said Lee, adding, “There are clearly some questions about the value of our role and the value of our field.”

Addressing these “vulnerabilities in our health services” will involve teamwork across specialties to reduce costs via more efficient diagnosis, better management of complex patients, and reduction of pharmacy costs, which her analyses show to be pivotal points. Central to these collaborative efforts is the field of imaging. Where radiology was once a “profit center” it has now become a “cost center” and it must turn this around by taking a leading role in optimizing the quality/service/cost formula.

"There is no leadership in this space," said Lee. “So this is a perfect opportunity for radiologists to step up and say we own it.”

Deploying imaging to assess the value of new tests, new drugs, and new devices, and integrating imaging into better clinical diagnosis and better decision-making will help avoid errors that drive up costs and advance procedures to enhance efficiency. To the question, “Can radiologists ‘own’ responsibility for accurate and timely diagnoses to drive value?” Dr. Lee emphatically indicated, yes — they must.

Business Affairs Homepage