Patient-centered health care has been a buzzword for some time, but the middle ground where patients and their providers meet is always shifting, according to the presenters of a December 3 session at the 2013 annual meeting of the RSNA in Chicago, Illinois. Susan John, MD; Elliot Fishman, MD; and Brent Wagner, MD, presented “Patient-Centered Radiology” to explore how engagement with patients is changing. As Wagner puts it, “All the things we might do to make our practices more patient-centric are a balancing act between opportunities and challenges.”

It’s a question on the minds of many in the imaging community: How can a specialty with very little patient interaction built into its workflow improve its service to patients? As an emerging practice model, patient-centered radiology has a nice ring to it, but as Greg Thomson, CPA, executive vice president with Zotec Partners, notes, “This represents a major cultural leap for radiology. Radiologists have long had multiple customers—including referring physicians and hospitals—along with patients, and because they often do not interact with patients, their focus has been on the referring physicians, not the patients. It is a mindset shift for the specialty.”

Like most radiology practices nationwide, Pueblo Radiology Medical Group, based in Santa Barbara, California, is facing the imperative to do business differently than in the past. Wayne Baldwin, CEO of the 18-radiologist practice, attributes the shift to changes in the regulatory environment that have made today’s radiology marketplace anything but “business as usual.”

Many radiology practices, by now, have been persuaded of the importance of deeper alignment and integration with their hospitals and health systems. Jana Landreth, director of practice management for Zotec Partners, says, “If your hospital approaches you wanting this, you need to embrace it. Going into this with reluctance or hesitation will not move your relationship forward, and the odds are that you will wind up doing it eventually anyway. If you embrace it now, you will be able to set the goals with the hospital and make them realistic for what your practice can achieve.”

If you work in radiology group practice, it’s likely you are considering your market position and evaluating whether you should be growing—if you haven’t expanded already. Depth of subspecialization, round-the-clock service and economies of scale are all necessities for imaging in markets experiencing consolidation. In short, if your hospital and health system customers are increasing in size, you should be as well.

As accountable care organizations and other forms of integrated delivery networks take root nationwide, independent radiology practices are experiencing a phenomenon not regularly seen since the 1990s: capitated contracts. “The biggest change our group has seen recently is the rise in capitated contracts, where we receive a fixed reimbursement for providing imaging for a whole patient population,” says Whitney Edmister, MD, PhD, of Desert Radiologists, a 54-physician practice based in Las Vegas, Nevada. “We receive a monthly payment to provide all necessary imaging services, allowing health plans to better control their costs.”

UnityPoint Health, formerly Iowa Healthcare, a multi-city integrated delivery system based in Des Moines, recently underwent a transformation aimed at empowering primary care physicians to take the lead in care coordination for patients.

As health care moves from fee-for-service to value-based medicine, and, eventually, to population health management, imaging is facing the imperative to redefine its role in the care continuum. “We’ll be focused closely on value and outcome measures in the environment we’re calling imaging 3.0,” says Mike Tilkin, CIO of the American College of Radiology (ACR). “Radiologists will play pivotal roles throughout the care process—from the time a study is ordered to being engaged as a consultant throughout the care cycle to being a resource to the patient.”