As usual, I was considering blog topics as I entered my office this morning. Looking down there was a letter sitting on my desk. It was from one of the stand alone radiology offices in town, the one I personally go to every year for my mammogram. I go there because they are accurate, friendly, and efficient. However, because they were one of the busiest in town I always got a first morning appointment. This past January when I went for my yearly exam the waiting room was empty. One person came in while I was in there. Because Dr. Irwin knows me I went back to the reading room while she looked at my "films" (they aren't really films anymore, they are digitized images). She quickly reassured me that my mammogram was normal then we moved on to other topics. We have known each other for years and we talked about our kids and spouses. Then she asked me how I liked being an employee for the hospital instead of private practice (and oh by the way--another day, another blog topic!). Admitting just how much I did like it, she smiled and said she was glad for me. Then she said, "All our referring physicians are being bought by the hospitals so all our patients are staying in those hospital systems for their radiologic procedures. I hope you can continue to refer to us." She didn't say it, but I heard, "They are killing us out here".
While researching today's topic I found this article by a financial advisor who seemed almost gleeful to report that hospitals might be able to purchase freestanding imaging centers at "depressed" prices due to current market forces which include reduction in reimbursement and continued increase in expenses. Depressed is the word, as I see the end of physician entrepreneurs and the furthering of corporate entities in medicine along with most other industries in this country. (If you are interested in further reading, here is an excellent, albeit technical, white paper on the issue: DRA's Effect on Imaging Centers).
Is this for better or worse? Who can say. So far, it is difficult for me to see a clear improvement in my patients' lives by this industrialization of patient care. I know we are supposed to be moving toward patient-centered care with ACO's and the medical home. With these new ways of delivering care, reimbursement formulas will change and who knows if this will improve or worsen care? Those studies are in process.
Today I know patients are not better served by being forced to go to larger centers, i.e. hospitals, for their imaging studies. And tomorrow? I just hope HAL is not in charge of the ACO's pod bay doors.