A Radiologist's Primer on Bundles and Care Episodes.

Bundled or episode payments are among the most heavily emphasized approaches to aligning incentives and promoting care coordination, efficiency, and accountability in health care redesign. Bundled or episode payments price a market basket of services for an entire episode of care with both a clearly defined trigger and termination. Because the radiologist is "ancillary" in many bundles, the specialty is often unaware of the phenomenon. This is likely to change rapidly. Radiology is pivotal in high-prevalence, high-impact care areas such as low back pain and stroke that are focuses of widely used system performance metrics. More important, radiology is central to the diagnosis and management of a wide range of important diagnostic issues in areas such as breast cancer, pulmonary nodules, and incidental findings. Three models of bundled care will probably involve radiology intimately in the near future. Pure radiology bundles might be constructed for breast cancer screening and diagnosis, and these could be priced on the basis of guideline-based best-practice frequencies of care events such as recall and biopsy. Clinical bundles, for example low back pain, could be priced on the basis of optimal imaging frequencies. Finally, pricing of imaging studies might include evidence-based frequencies of follow-up imaging for incidental findings.

Leadership in conflict: part 2.

Don't start stupid fights, and don't make enemies (except on purpose!). Fight for a reason or a goal. Have a plan for ending the conflict that includes the details when, where,why, how, and who. Within the fight, see it as a complex negotiation. Although you may get emotional, try to stay cerebral and understand what you and your opponent are doing and when it is time to stop. When the fighting stops, repair the damage and start preparing for the next conflict.

Leading from below.

Professionals can and should lead, regardless of where they are in an organization. Formal approaches to leadership activities can improve outcomes for leadership at all levels in an organization. In the types of organizations most radiologists practice within, leadership is simply too important to be left just to one person.

ACR white paper: Strategies for radiologists in the era of health care reform and accountable care organizations: a report from the ACR Future Trends Committee.

Accountable care organizations have received considerable attention as a component of health care reform and have been specifically addressed in recent national legislation and demonstration projects by CMS. The role or roles of radiologists in such organizations are currently unclear, as are changes to the ways in which imaging services will be delivered. The authors review concepts fundamental to accountable care organizations and describe roles for radiologists that may facilitate their success in such health care delivery systems.

White paper from the ACR Task Force on Print Media in Radiology.

The rapidly changing technological and business environment in which scientific journals are published will necessitate ongoing reassessment of operations, goals, and priorities. In this white paper, the ACR Task Force on Print Media in Radiology reviews the history and role of print media in radiology; discusses current and anticipated societal, technological, and financial challenges; and explores a variety of strategies to help ensure the relevance of professional society publishing in the future.

Leading change in an organization.

Change leadership is a core function of your leadership role. Learning to do it better will help you in many of the other tasks you face in your position. Change and adapting to it are not optional; change is simply a fact in the environment. Ignoring it in your job is no less critical than trying to ignore an oncoming truck in the wrong lane. Change leadership will be easier for you and your organization if it is embedded in policies and smart practices rather than done in an ad hoc fashion.

Principled leadership.

Leadership is not just a set of activities; it is also about vision and character. Principles matter: for you, for your coworkers, and for the group or institution you serve. Individuals and groups can succeed only through a climate of commitment and trust. Your integrity and principled leadership are the cornerstones for building an effective team. Following principles doesn't mean that you will win every time, but having a plan and sticking to it even in tough times is a strong element of long-term success.

Scenario analysis and strategic planning: practical applications for radiology practices.

Modern business science has many tools that can be of great value to radiologists and their practices. One of the most important and underused is long-term planning. Part of the problem has been the pace of change. Making a 5-year plan makes sense only if your develop robust scenarios of possible future conditions you will face. Scenario analysis is one of many highly regarded tools that can improve your predictive capability. However, as with many tools, it pays to have some training and to get practical tips on how to improve their value. It also helps to learn from other people's mistakes rather than your own. The authors discuss both theoretical and practical issues in using scenario analysis to improve your planning process. They discuss actionable ways this set of tools can be applied in a group meeting or retreat.

Advanced marketing: how to protect and advance your practice.

Radiology practices in the United States are facing mounting competitive challenges in many metropolitan areas. This competition is multifaceted and includes other traditional diagnostic imagers. However, the most severe pressures are from new entrants, such as primary and specialty physicians outside of radiology. The business science of marketing provides a set of solutions to help you fight back against this onslaught. In particular, advanced marketing techniques offer compelling strengths for raising awareness of the unique nature of our specialty among both the lay population and primary referrers. Applications of advanced marketing can be used to simultaneously hold and expand your turf. Relying on smarts rather than dollars, they also help overcome the fears that many radiology practices have about the high costs of traditional broadcasting.