The Longevity Imaging Brief · Issue 03

The Longevity Imaging Brief — Issue 03

Radiology is priced by the study. Its value arrives by the decision.

priced vs. valued

One considered briefing a month on the economics, evidence and governance of preventative imaging — for insurers, health systems, policy teams and investors who need the signal without the sales pitch.

The signal this month

Every health system pays for radiology the same way: per study, per relative value unit, per read. It is a volume meter bolted onto a specialty whose entire contribution is a decision — the diagnosis that redirects a treatment, the confident negative that halts a workup, the incidental catch that changes a life. The unit we pay for and the value we receive are measured in different currencies, and the gap between them is where the strategic opportunity in imaging actually sits.

The European Society of Radiology put the problem precisely: mainstream value-based healthcare frameworks treat the diagnosis as invisible — counted only when it is wrong or causes a complication — when in fact a correct diagnosis is the first outcome that matters to a patient [S6]. If you cannot see the diagnosis on your value dashboard, you will systematically under-invest in the thing that produces it.

Where the value actually lands

In the redirected decision. The value of a radiology report is not the report; it is the change in what happens next. A coronary calcium score that reclassifies an intermediate-risk person to high-risk and starts a statin [S1][S2], a bone-density read that catches osteoporosis before the first fracture [S8][S10], a body-composition profile that flags metabolic risk years early [S11][S13] — each is worth many multiples of the imaging fee, and none of it shows up in a per-study tariff.

In the imaging that doesn't happen. A well-judged read prevents the diagnostic cascade — the confirmatory scan, the follow-up, the biopsy chasing a finding that never needed chasing. Value-based radiology counts avoided redundancy as a positive, not a lost revenue line [S6]. A fee-for-service model counts it as a fee foregone. The incentives point in opposite directions, which is precisely the problem.

In the confident negative. A definitive all-clear has economic value: it ends anxiety, closes an episode, and stops spending. That value is real even though nothing was found — and it is invisible to any system that only pays when something is.

The counter-case, stated plainly

Value-based radiology is easy to assert and hard to measure, and honesty requires naming that. The metrics for a radiologist's contribution to outcomes are still immature; more than 80% of patients in a 22-country survey had never heard of value-based radiology or value-based healthcare at all [S7]. There is a real risk that "value" becomes a slogan that justifies whatever the speaker already wanted — more screening for the advocate, less spending for the payer. The discipline is to tie each value claim to a measured change in a decision or an outcome, not to a story about one. Where that evidence does not yet exist, the honest answer is that we are measuring an input and calling it a result.

There is also a volume-quality tension the specialty rarely says out loud. Systems that reward reading more studies faster are not, on their face, rewarding the unhurried second look that catches the opportunistic finding. You cannot ask radiologists to add value and pay them only to add throughput.

What I'd watch next

The organisations that win here will stop trying to pay for value in a single number and instead instrument the whole chain: did the report change the plan, did it prevent a downstream scan, did the finding get actioned. That is a governance and data problem before it is a payment problem. It is also, not incidentally, the case for keeping a credentialled radiologist close to the decision rather than at the far end of a queue — which is where next month's issue goes.

References

Written by Dr Lisa Sorger — consultant radiologist, healthcare executive, medical administrator, company director and founder of myradiologist.ai. Every figure in this issue is sourced to the public record; the source register is available on request.

Next issue: The value of talking to the radiologist — direct consultation as the missing outcome.

All views expressed here are my own personal opinions and are not medical advice. General information only — not clinical or financial advice. myradiologist.ai · ABN 29 692 758 115 · ACN 692 758 115