What will it take to bring payers on board? The medical director of a benefits management organization observed that doctors see great results with ultrasound in academic settings for MSK and other conditions, but payers will want to see this translated to community-level hospitals or clinics. He said insurance plans could be convinced to back ultrasound first, but not if every ultrasound led unfailingly to an MRI because the ultrasound scan was ambiguous or uninterpretable.

One popular suggestion — which drew hearty applause when mentioned by AIUM president Dr. Alfred Abuhamad — was encouraging the accreditation of more facilities in ultrasound, as a marker of quality and to ensure better training.

Of course, economics might carry the day in the end. As the payment system transitions from fee-for-service to accountable care organizations and other models, it will hugely influence what exams get ordered. "If we have only a limited amount of funds that's going to be the primary driver of what's going to happen," said Dr. Bruce Gilbert, the director of ultrasound with the Arthur Smith Institute of Urology at North Shore-LIJ Health System.

In his talk earlier in the morning, Nazarian also stressed the importance of economics.

"I've always said if ultrasound reimbursed three or five times more than MRI, this would be an MRI first forum," he joked.

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