The new health care reform law brings three challenges--more patients, new care guidelines and low payments--to all providers, says Christopher Buckle, M.D., a radiology resident at the University of Chicago.

A prime goal of reform is to provide health insurance to 30 million individuals currently not covered. But that will create pressure on accessibility of care because of the clinician shortage in radiology and many other specialties. And because many of the newly ensured will be covered under low-paying Medicaid, that will create pressure on payment for services. Consequently, practices have to become more efficient, while also adopting evidence-based care which insurers of all types will increasingly demand as a condition of payment.

At RSNA 2010, Nov. 28-Dec. 3 in Chicago, Buckle will co-present a session exploring how health care reform will change the radiology field. For instance, picture archiving and communication systems have been revolutionary for radiology and have significantly improved workflow, Buckle notes. But PACS have to become more efficient because radiology practices have to find every way possible to improve efficiency.

For instance, information technology staff at the University of Chicago have tweaked the PACS so clinicians can right-click on an image and immediately pull up any associated pathology reports from the electronic health records system. The clinicians also can, on the PACS, page other authorized personnel to communicate results to them.

The stimulus law funds comparative effectiveness research now being conducted will further compel radiology firms to practice evidence-based medicine in a reform-changed industry, Buckle cautions. For instance, how often do radiologists follow-up with patients treated for cancer to detect a re-occurrence? "Comparative effectiveness research will try to find out and eventually follow-up will be tied to payment," he predicts. "Insurers will only pay for the best and most appropriate treatment." A special note to cardiologists and cardiology radiologists: A top priority of comparative effectiveness research is management of atrial fibrillation, according to Buckle.

The lasting impression he hopes to leave at the session: Patients, practice and payment aren't just are the three top challenges, but also the three top promises of reform.

Session LL-PPE-SU1B, "When the Dust Settles: Radiology After Health Care Reform," is scheduled on Nov. 28 at 1 p.m. More information is available at

--Joseph Goedert


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