I have been musing about the past 24 years that I have been involved in the business side of radiology and how amazing the transformation of this profession has been during that time. Interestingly, the issues we face today mirror those that we faced in 1983 as prospective payment was then unceremoniously ushered (thrust?) into existence, creating the first of several subsequent tectonic shifts in the way the business is conducted and services are paid for.

Now we have "pay for performance" (P4P) on the horizon and pending shifts in the sustainable growth rate (SGR) formula to add to the litany of "adjustments" to the economic model for reimbursement that begin with the government programs and then migrate to the other payors. The assault continues and will continue unabated.

My view is that what lies ahead will quite possibly make the DRA seem comparatively mild in terms of its overall contribution to the level of angst that the business will experience. Cuts added to more cuts added to increased market pressures added to the consumer movement--with the last perhaps changing the way we do business more than the others combined—will require all of us to be more skilled at "the business of radiology."

What about this increasing role of the patient in the outpatient business proposition?

It is clear that we will need to get used to the concept of consumerism and informed patients who will demand more, expect a positive experience, and who will change the face of radiology perhaps more than anything else we have seen to date. The Internet is empowering patients in new and unique ways, and the economic incentives are aligning in ways that mandate they take control of their own health care. Employers will continue to ask the employee to assume an increasing share of the health care benefit expense and this cost-sharing will result in patients (consumers) demanding to be an integral part of the decision chain.

So what does this mean for outpatient radiology practice business plans? Plenty. The marketing assumptions that most practices include in their strategic plans (assuming such plans exist) typically give only a peripheral nod to the influence of the patient, with the notable exception of mammography and, increasingly, vein labs and CTA. However, in order to build lasting brand equity and significant levels of awareness and preference among this increasingly important customer base, it will become critical to find ways to build customer service programs around the "referral chain" that each patient potentially influences.

This will mean that everyone within the practice will need to become acutely aware that each and every encounter with a patient will affect the long term viability of the business in either a positive or negative manner. We can no longer take the patient for granted as a passive influencer of the referral decision. They will be part of the program and can become either loyal advocates for your business or catalysts for your competitors.

The successful practices of the future will be those who pay attention to the many faces that comprise our business.