Radiologists, travel agents and whale oil salesmen


Recently, the Department of Veterans Affairs (VA) proposed a stunning new rule that would allow certified nurse practitioners (CNPs) to “order, perform, supervise and interpret complex imaging studies,” such as MRI and CT, without physician oversight and regardless of state law.

James Borgstede, M.D., (Professor of Radiology-Diagnostics at the University of Colorado at Denver) warned of this more than eight years ago at the RSNA 2007 Annual Meeting. In “Radiology: Commodity or Specialty?” Borgstede claimed that the profession of radiology requires the integration of four linked components:

  1. Pre-examination evaluation for necessity and appropriateness,
  2. Monitoring of exam quality,
  3. Interpretation of exam results and,
  4. A post-examination consultation with the referring physician.1

In many hospital imaging departments and IDTFs, radiologists perform only the interpretation and have little or no involvement (or interest) in the remaining three responsibilities. Combine this with the growing trend toward outsourced teleradiology on nights and weekends along with radiologist’s lack of visibility to both referring physician and patient, and it’s no wonder the “commodity perception” exists.

Borgstede also claimed that technology is “driving the radiology specialty toward commoditization through digitization, increased bandwidth, picture archiving and communications systems, computer-assisted detection, and improved transfer software.”

There is no doubt that the advent of technology has and will continue to transform industries. The light bulb and cheap electricity rendered gas lighting obsolete, which in turn had replaced the various derivatives of whale oil, lard, coal and alcohol used for burning in the mid-1800s. The internet gave rise to self-serve travel websites which decimated the ranks of travel agents as consumers found they could do just as good a job at booking their own travel, while saving themselves money in the process.

Yet, obsolescence need not to be the destiny of the radiologist. Those in the know understand that their work is too valuable to be left up to less experienced clinicians whose skills and training simply cannot compare, and which would negatively impact quality.

According to Paul Ellenbogen, M.D., former Chairman of the Board of Chancellors of the American College of Radiology, “radiologists should focus more on consulting with patients and referring physicians, assessing the appropriateness of imaging requests before doing the studies, controlling utilization management, serving on hospital committees and boards, and participating in conferences and grand rounds of other specialties.”2

In other words, you need to become more useful to physicians and improve you visibility.

However, becoming more “visible” with a heavy workload can be challenging. That’s where marketing comes into play.

With marketing, you can educate referring physicians, inform them of new services relevant to their practice, communicate positive changes within your organization, postulate opinions and much more. Marketing serves as the radiologist’s voice within the physician community, and can help overcome misperceptions or clarify issues that negatively impact your profession.

Marketing also represents and opportunity for you to build awareness and credibility among patient populations. For too long, radiologists have ignored this extremely important audience, as patient demand can actually shape and influence physician referral patterns. Put simply, if you haven’t given your patients an explanation as to why you are a critical part of their care, why should they care who reads their study?



  1. Radiology: Commodity or Specialty, James P. Borgstede, MD, From the Department of Radiology, University of Colorado at Denver and Health Sciences Center, 12401 E 17th Ave, Aurora, CO 80045. From the 2007 RSNA Annual Meeting. Received December 19, 2007; accepted January 7, 2008; final version accepted January 10
  2. Ellenbogen P . The “P word.” J Am Coll Radiol. 2012;9:603




Medicare Sustainable Growth Rate Formula Gets Permanent Fix

The dreaded sustainable growth rate (SGR) formula, and the numerous temporary “doc fixes” associated with it, has finally been “fixed.” This fix means the SGR has been replaced with a permanent legislative solution. The new legislation passed by Congress and signed into law effectively ends the SGR formula used to create the Medicare physician fee schedule, replacing it with a permanent reimbursement plan and value-based care incentives.

Implemented in 1997, the SGR is a formula designed to limit growth of Medicare Part B spending by linking changes in reimbursement to the growth of the U.S. economy as a whole. Since that time, proposed cuts in the SGR have been delayed 17 times by so-called “doc fix” bills, with short-term fixes often paid for through physician payment reductions. Diagnostic imaging, for example, was particularly hard hit, with advanced diagnostic imaging services such as CT, MRI and PET/CT experiencing repeated payment reductions. These temporary fixes simply delayed the inevitable while increasing financial pressures and uncertainty for health care providers.

No matter how one feels or what one knows about “the fix,” what it brings to medical practices, including radiology groups and imaging centers that medical marketers work with every day, is stability and predictability. Not surprisingly, the bureaucratic complexity and questions of implementation remain. This does, however, quell the economic storm that has been swirling around the SGR for the past 17 years.

Without the permanent fix, the Centers for Medicare and Medicaid (CMS) was planning a predicted 21 percent cut in Medicare reimbursements. With the repeal and replacement of the old methodology, regulators have developed a new payment model that incorporates a base fee increase of .5% to the Medicare fee schedule annually over next 5 years, with bonuses for quality care improvements and patient centered medical home participation. At that point, individual physicians could earn incentive payments through either an Alternative Payment Model (APM) program or the new Merit-Based Incentive Payment System (MIPS).

Starting in 2019, CMS will establish MIPS as part of its efforts to move from a fee-for-service payments system to a value-based system. The MIPS payment program assesses the performance of each eligible provider based on quality of care, resource use, clinical practice improvement and meaningful use of electronic health record technology.

Medicare physician payment rules and guidelines remain extraordinarily complex, and a myriad of policy details remain to be worked out. However, the bottom line for the medical community is that a stable Medicare fee schedule will result in a positive effect on the revenue cycle and payments, allowing more accurate and successful business planning and marketing.

Sources and resources: 

H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015

The most important details in the SGR repeal law

A primer on Medicare physician payment reform and the SGR

Obama Signs SGR Repeal Legislation; Value-Based Payment Model Comes Into Full Force in 2019




Marketing Interventional Radiology to Hospital Physicians

Client: Affiliates in Imaging

Project: Physician-Marketing Campaign to Promote Interventional Radiology Services

Planning/Goals of the Project:

Affiliates in Imaging is a group of more than 20 radiologists in San Francisco and the Bay Area specializing in both diagnostic imaging and interventional radiology (IR). The group contracts with area hospitals and medical centers to provide expert diagnostic imaging interpretation and minimally invasive treatments.

In 2011, the radiology group implemented some positive changes as well as new services to improve its image among hospital partners. Affiliates hired Armada to help communicate these changes to hospital-based physicians in a marketing communications program — the effectiveness of which would be evaluated in an annual survey of these physicians.

In this first year of working together, Armada helped Affiliates increase physicians’ favorable perceptions of its radiology services in all key measured areas, compared with 2010 survey results.

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Knowledge is the New Pink


Happy Halloween! It’s the last day in October and most of us are putting away the pink and donning our pumpkin orange. Pink has become the international symbol for dedication to Breast Cancer Awareness Month (BCAM). And this year we saw more and more efforts drawing upon awareness, support and knowledge.

Months ago, when we were collaborating on radiology marketing strategies for our diagnostic imaging clients, we recommended adding a highly focused on social media component for BCAM in addition to traditional marketing communications.


Our Objective

Reach out to patients on Facebook and arm them with valuable health information.


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