Working Together to Build a Better Measure
Radiology has changed dramatically over the past two decades.
Across the country, radiology groups have merged, health systems have grown larger, and practice models have evolved in response to economic pressures, workforce challenges, and changing healthcare delivery systems. While many of us recognize these trends anecdotally, there remains an important question: How do we actually measure consolidation and how does it impact radiology practices and the workforce?
Those questions are what inspired my team's application to the Harvey L. Neiman Health Policy Institute's (HPI) Richard Duszak Grant. We proposed to develop a standardized approach to evaluate consolidation in the radiology workforce by adapting an existing measure--the Herfindahl-Hirschman Index (HHI)—and using it to study consolidation over time. The proposal was selected for support from the HPI through the Duszak Grant this year.
As someone interested in radiology economics, health policy, and workforce, I was immediately drawn to the opportunity the Duszak Grant offers. The grant not only provides the opportunity to collaborate closely with Neiman HPI's research team and leverage their expertise and access to multiple large healthcare data sets, but also creates a unique opportunity to collaborate with leaders who have shaped the field of health services research in radiology. Given the clinical demands of radiology practice today, it is increasingly challenging to collect data and conduct complex research—and funding for health policy research that has always been sparse is now nearly non-existent.
In particular, the opportunity to receive mentorship directly from Richard Duszak, MD, through the grant is incredibly meaningful. His contributions to economics and health policy research have helped define how our specialty evaluates value, access, utilization and workforce trends. His leadership and previous work, as well as the continuing work of the HPI, has had a profound influence on radiology by providing key evidence that directs ACR strategy, enables advocacy wins for the ACR members, and helps leaders across the radiology make sound practice management decisions.
Our project focuses on using the Herfindahl-Hirschman Index, or HHI, a widely accepted measure of market concentration, to better understand consolidation among both radiology practices and healthcare systems. Specifically, we plan to examine the largest Core-Based Statistical Areas in the United States—geographic clusters of communities and job markets between 2015 and 2025 and evaluate how consolidation has evolved during that period. A huge benefit of working with HPI researchers on the project is their access to physician and patient records from insurance claims that cover approximately 100% of practicing radiologists and over 60% of the patient population across all major payer types – Commercial, Medicare and Medicaid.
Ultimately, our goal is not simply to describe consolidation, but to better understand the drivers and implications of what we observe.
For example, does increasing health system consolidation lead to subsequent consolidation among radiology groups? Do highly concentrated markets experience different workforce dynamics than less concentrated markets? How might consolidation influence radiologist turnover, subspecialization, or the use of non-physician practitioners? These are important questions at a time when workforce challenges are top of mind for many radiology practices.
What excites me most is the potential for this research to serve as a foundation for future work. One of our long-term goals is to help develop tools that allow researchers and radiology leaders to better visualize and understand consolidation trends over time. By creating new ways to measure and track these changes, we hope to generate insights that can inform strategic planning, workforce development, and future policy discussions.
It is these opportunities for collaboration and mentorship, as well as access to unique resources, that make the Richard Duszak Grant so valuable. This enables me and my collaborators to make meaningful contributions to the future of our field through our work and ultimately the publications that result.
Radiology faces no shortage of complex challenges and opportunities. Whether the topic is workforce shortages, emerging technologies, evolving payment models or cancer screening policy, meaningful progress depends on rigorous research and access to high-quality data. The Duszak Grant provides investigators with the support needed to tackle those questions and translate ideas into impactful studies, with the ultimate goal of – true to Dr. Duszak himself – improving data-driven decision-making.
For researchers who have considered pursuing a health policy project or have a burning question but are not sure where to start, I would strongly encourage them to explore the Duszak Grant. The combination of Neiman HPI's analytical expertise, collaborative environment, mentorship, and data resources creates a unique platform for advancing innovative research and opening new career opportunities in research.
I am grateful to work with our team - Andy Moriarity, Shannon Farmakis, Chelsea Schmitt, Eric Rubin, and Tim Crummy - alongside the Neiman HPI team and excited to see where this project leads. More importantly, I'm hopeful that our findings will help contribute to a deeper understanding of how consolidation is reshaping radiology and what those changes mean for the future of our specialty so that we can adapt for success.
Applications for the Richard Duszak Grant are open through September 29. Learn more about the program and how Neiman HPI supports innovative health policy research in radiology.
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