Walmart health and its implications for imaging

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Walmart has opened five primary care offices across the country with plans to add more. These offices are in/near their stores. And, the supply-chain-rich, nationally-networked behemoth has decided to roll out this initiative by targeting underserved populations. (Do you think the increasing number of Medicaid-covered patients influenced their decision?)

I don't need to spell out the implications of Walmart's entry into healthcare for this crowd. The days of patient's visiting a private doctor's office for basic primary care needs may, in fact, be numbered. While primary care docs will stridently argue that the care they provide is superior to that received/delivered at the local super-center, their sentiments fail to answer the more important question. Rather than asking which care is best, instead we must ask, "Is the care that Walmart provides good enough?" And if it is, then they will win, and win big.

Visits to get a Z-pak for a cold, Lipitor for hypercholesterolemia and routine Hgb-A1C checks for diabetics will vanish from private doctor offices. And we have to ask, who is better suited to manage the health of our population than a nationally established, lean company like Walmart that can instantaneously implement standardization and common practices to optimize utilization of precious healthcare resources? Especially when the razor-thin margins that they're accustomed to render them willing and able to care for our poorest citizens.

This is a big deal. 

Consequently, it is necessary to ask ourselves, "What is next?" I argue that imaging will be the next service offered at discount prices by our local stores. "Welcome to Walmart! Would you like to get a mammogram today?"

Radiologists and hospital administrators must be prepared for this. Screening tests will be offered first. Mammograms, CT colonography and even our beloved CT lung-cancer screening tests likely will be available for purchase. They'll probably even offer specials, deals and coupons to influence consumer behavior. "Get a low-dose screening chest CT and get a free 2-liter of Diet Coke. Today only!"

How will we respond?  Will we fervently declare that our images are better? That our radiation dose is marginally lower? That our yet-to-be-defined quality is superior? None of these questions matter if Walmart does good enough. Period. If we're honest with ourselves for a moment, who do you think would run a more efficient CT-scanning operation with the lowest overhead costs, a hospital or Walmart? It's a scary thought, and fortunately the current situation causes us to spend time reflecting on our performance. Scarier yet, do vendors realize the purchasing power Walmart has? I'm sure they've thought about it. How far do you think they can drive the price down for new CT scanners?

I certainly am not endorsing that we all should aim for "good enough" rather than "great." But this form of disruptive healthcare will eventually displace antiquated, traditional healthcare delivery and imaging-service models. Perhaps we should consider ourselves lucky. This move by Walmart to distribute and provide healthcare in an established, efficient and enormous business network forces us to look at what we do every day, to examine our strengths and analyze our weaknesses. It brings to light, with greater clarity, the fact that radiologists need to redefine what we do. Rather than being in the business of imaging (which can be mass-distributed and offered at discount prices), we need to be in the business of diagnosis. This charge is already being led by many smart radiologists such as Jim Brink of Massachusetts General Hospital and Bibb Allen, chairman of the American College of Radiology Board of Chancellors.

But in order for this transition to be successful, we all have to buy in. The commoditization of imaging has been under way for some time now. Walmart's entry into healthcare will only accelerate the race to bottom. Let's use this opportunity to focus our energy on redefining what we do and find ways to become the experts for diagnosing illnesses. Not just acquiring images. Let's find new partners (such as our pathology colleagues), new methodologies and new workflows to ensure that every patient is diagnosed quickly and correctly. Every time.

Can we embrace that vision?

Matt Hawkins is a pediatric interventional radiologist and an assistant professor in the department of radiology and imaging sciences at Emory University in Atlanta. He also serves on FierceHealthIT's Editorial Advisory Board.

Prior articles by the author:
Re-recognizing the importance of radiology's professional community
H.R. 4302: Duct tape, delays and decision support
Reimbursement in medicine: One radiologist's perspective
Keeping score with revenue: The 2-step-back feedback
It's time to end diagnosis fragmentation
RSNA13: Business analytics, clinical decision support take center stage for radiologists