Gatekeeping: A Radiology Firing Line Podcast
Changing health care delivery systems are shifting gatekeeping roles and risks in unexpected ways.
A gatekeeper controls access to something. In medicine, an optimal gatekeeper minimizes wasteful, inappropriate care while allowing access to necessary, or at least appropriate, care. However, as physicians are not only health care providers but also consumers of health care, we know that the gate is broken and the gatekeeper is too often asleep on the job.
Join Radiology Firing Line host Saurabh (Harry) Jha, MD, as the podcast takes a slight detour from its typical collegial debate format. Dr. Jha interviews H. Benjamin Harvey, MD, JD, a neuroradiologist at Massachusetts General Hospital, who gives us a brief master class on the complex regulatory environment surrounding gatekeeping in medicine. He demystifies concepts such as utilization review and radiology benefits managers and then prognosticates about the impact of contemporary shared-risk contracts on health care systems, especially accountable care organizations.
Another definition of gatekeeping can be found in media communications, in which gatekeeping involves filtering information before public dissemination, i.e. controlling access to information. In the podcast, Dr. Harvey breaks through a heavily fortified communications gate, unlocking a well-guarded secret about the shifting of gatekeeper duties from insurers to health care systems. He exposes a lack of legal accountability with straightforward remedies for bad health outcomes that are attributable to gatekeeper errors. But he also explains how health care systems without federal protections are assuming more of the risk for those errors than federally protected insurers.
If you are interested in further exploring the topic of this podcast, here is suggested reading from the JACR and other sources: