Contributor: Beverly Bradway, WG’91
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Beverly Bradway WG ‘91
James Whitfill, MD, is Senior Vice President and Chief Transformation Officer of HonorHealth, Chair of Society for Imaging Informatics in Medicine, and President of Lumetis, LLC a national healthcare consulting firm. He received his MD from the University of Pennsylvania and completed his Residency and Chief Residency in Internal Medicine at the Hospital of the University of Pennsylvania. He was the first physician to complete a fellowship in Medical Informatics in the University of Pennsylvania Department of Medicine.
Q: You’re trained as an MD but you ended up on the business side of radiology. How did that come about?
A: After earning my MD from Penn Med, I pursued a fellowship in medical informatics under David Asch, MD, currently the John Morgan Professor at Wharton (as well as Executive Director, Center for Health Care Innovation, and Professor of Medicine, Medical Ethics and Health Policy, Healthcare Management, Operations, and Information and Decisions). My research focused on using data as a tool for predicting sickness and disease at a time when using that information, now known as bioinformatics, wasn’t even a field of study. While electronic healthcare records are commonplace today, back in 1999 when I completed my research radiology was one of the few specialties embracing it. It was the possibility of getting engaged as a pioneer in digital workflows that appealed to me.
Q: What changes have you seen within radiology?
A: Technology is driving broad and rapid transformation. Twenty years ago when I began my career, the practice of radiology relied on ‘analog’ media and on-site radiologists. It was a local business, and radiologists worked in hospitals or within physician groups closely aligned to care settings. The settings required large, expensive machines and images were stored in large film jackets housed in storage rooms. Radiology was also a ‘lifestyle specialty’ that allowed radiologists to practice with predictable schedules and few after-hours responsibilities.
Radiology is very different today because digital imaging is allowing us to do more. The process of doing an x-ray is faster, images are better quality, and different radiology modalities allow for better clinical information and treatments. Furthermore, there is no need for large file space as images can be accessed from a computer at any time.
Radiology has also been enhanced by increased interconnectivity and communication among devices including mobile system access. For example, while providers used to be on-site for analysis and interpretations, today that can be done by simply logging into a computer. In addition, while second opinions used to come from a practice partner, today that opinion might come from a specialist across the globe. We also have the ability to access specialized computer software to assist with interpretations.
Q: Has investment in technology led to better overall profitability in radiology?
A: Unfortunately, no. Even though radiology was quick to embrace technology and measurably improve our ability to understand, diagnose, and treat patients, reimbursements have continued to decline because of pressure from policy makers and payers. Technology is not only expensive, it introduces other challenges as well, such as the need for training, facility/building accommodations, workflow adaptations, and more.
In my consulting practice, we team up with radiology groups of all sizes to help leverage informatics, analytics, and workflows. We also support aspects of technology integration. Given the pace of technological improvements, it is no surprise that every conversation I have about the future of radiology is complicated and multi-layered. Sorting through it can be challenging, and radiologists are having to become quickly adaptable.
Q: Is the role of the radiologist changing with technology?
A: Radiologists are no longer a behind-the-scenes practitioner, they are becoming central to patient care. While they used to be a complementary specialty, today the options within radiology allow for things such as screening, minimally-invasive treatments, monitoring findings and more, making radiologists important partners to patient clinicians. Some of the things we must consider as we look ahead is whether we expect radiology practices to be a one-stop shop for all scans and treatments and what role we expect radiologists to assume with regard to healthcare/patient cost control. There is real promise in the ability of technology to revolutionize the healthcare experience, but there are also fundamental questions that come with it.
Q: How are radiologists coping with the economic pressures?
A: Radiologists are becoming much more open to new corporate structures. One of the trends is consolidation, which we are seeing at local, regional, and, in some cases, national levels. While medical jurisdiction is still state-controlled, some radiology practices have found ways to obtain licensing in multiple states, allowing radiologists to work inter-state. Because of the 24/7/365 nature of radiology today, larger groups comfortably cover these needs while offsetting costs of care. In addition, we are seeing niche businesses evolve. With the advancement of technology and internet bandwidth, an industry known as teleradiology is emerging to supplement groups seeking different kinds of support.
We’re also seeing the arrival of private equity firms interested in both investing and re-shaping the way the business of radiology is practiced. Often these conveners bring a scale and a business focus that has been absent in smaller groups. So there is a new dimension to the competition practicing radiologists now face.
Q: Why is private equity interested in radiology? And, is it just radiology or are other specialties vulnerable to Wall Street advances?
A: Radiology has traditionally been an ancillary medical specialty in business formats that are privately-held, fragmented, geographically defined, and small but profitable. As a result, healthcare PE firms are hoping to tap a market where consolidations can lead to economies of scale, savings, and better margins. Radiology isn’t the first specialty targeted by private equity. Before radiology, private equity firms went after emergency medicine and then anesthesiology.
Having a partner, like a private equity firm, with deep pockets and incentive to create profit can be a bonus when a practice wants to go that direction. At the same time, as a physician, professor, and speaker engaged in national healthcare dialogue, I have concerns about approaching medicine like a commodity.
Q: And the future of radiology and the radiologist?
A: I think technological advances will answer that for us. In fact, this feels like a question that has brought us full circle on our conversation. Data will continue to be a powerful tool, and with enough data and mathematical modeling, we may soon predict illness, cancer, and disease from scans and images. This was the optimism I held during my fellowship several decades ago; I’m excited to see it on the horizon.
As for the future of the radiologist? I don’t believe algorithms and technology will replace their work, but physicians who use these tools will replace physicians who do not. Medical training and experience provide an important dimension of patient care that machine intelligence can’t replace. Those who are able to invest in technology and then leverage the information will continue to maintain the advantage.
Q: It seems there is a great Wharton Business School case study to be written on the challenges surrounding radiology.
A: Absolutely! The challenges facing radiology today and into the future present an excellent opportunity to consider business theory in the context of new problems, new paradigms, and growing possibilities. In addition, addressing the challenges will draw from knowledge related to policy, finance, marketing, information science, operations, and global influence. It’s a time that calls for thoughtful business innovation and strategic decision-making that healthcare business leaders will have to provide.
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