Next Up: Rationing Radiology?
By Curtis Kauffman-Pickelle

Here we go again! Just when the DRA impact is beginning to be felt as the A/R collections period from Q4 06 morphs into the reality of weaker cash receipts in Q2 07, the American College of Radiology (ACR) Regulatory Update that I attended at the recent Radiology Business Management Association (RBMA) meeting in St Louis revealed the insipient danger that lies ahead in the shape of further cuts in reimbursement, and not only the technical component.

I continue to be extremely concerned about imaging’s vulnerability on two levels. My first concern is the unrelenting assault on diagnostic imaging in certain legislative and regulatory quarters. And, second is the continuing apathy (deer in the headlights) and lack of alignment and cohesion around the country to fight back. It seems that as with the DRA battle, the heavy lifting for the upcoming fight will be left to the Washington insiders and our representative lobbyists such as Access to Medical Imaging Coalition (AMIC), ACR, and the National Coalition for Quality Diagnostic Imaging Services (NCQDIS).

While these entities all are doing an admirable job of keeping organized imaging’s story in front of the powerful and influential, the regulators will easily circumvent radiology’s Maginot Line since there is really no credible and sustained grassroots effort to demonstrate the true impact of further cuts on patients and all stakeholders in health care. They do not sense any hue and cry from the trenches and to them this means just one thing—complacency.

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Legislative Report: AMIC Perseveres in Battling Imaging Cuts
By Tim Trysla

Access to Medical Imaging Coalition (AMIC) was organized in early 2006, soon after Congress passed the Deficit Reduction Act of 2005, which significantly reduced the level of funding for medical imaging services provided in independent imaging facilities and physician offices. AMIC represents more than 75,000 physicians and medical providers, as well as numerous patient advocacy organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of American workers. AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it. The coalition conducts public affairs, advocacy, and educational activities to promote legislation to address medical imaging payment reduction issues.

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Radiation Dosage Monitoring in CT
By Pamela M. Harlem, MBA

Was it just a few years ago that potential to reduce exposure was one of the benefits touted for adoption of multi-slice CT?  Then, in 2001, the FDA issued a Public Health Notification to emphasize the importance of keeping radiation doses during CT procedures as low as reasonably achievable (ALARA).  Concerns with monitoring patient radiation dosage in CT are rising, in part due to a general trend toward patient safety and in larger part due to concerns within the medical community that multi-detector CT technology may actually be increasing exposure.

Massachusetts General Hospital radiologists have conducted studies and published in peer-reviewed journals findings that indicate the potential of upwards of 50% less radiation dosage is possible in some situations without any loss in image quality for interpretation. 

The conclusion?  As demand for CT continues to grow and technology allows capture of an ever-increasing number of images, the need for standardized policies for optimum radiation efficiency will increase.

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Dose Awareness Movement Gains Steam

Efforts to raise awareness of radiation dose in medical imaging saw significant activity on three fronts this past month, suggesting that radiology may be mobilizing to raise awareness of the issue. The National Council on Radiation Protection & Measurements (NCRP) released preliminary results of a new study showing a five-fold increase in exposure to ionizing radiation from medical devices by the general public. The American College of Radiology released a white paper providing guidance on limiting patient exposure aimed at all stakeholders in radiology. And the National Equipment Manufacturer’s Association released its own report detailing steps vendors are taking to reduce dose.

Preliminary results from the NCRP's forthcoming update of its 1987 report, Ionizing Radiation Exposure in the Population of the United States. Reprinted with permission.

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When Hartford, Connecticut-based Jefferson Radiology came calling roughly a year-and-a-half ago for Mark S. Grossman, he was happily ensconced in a large radiology practice in Cincinnati, Ohio. But the opportunity to serve Connecticut’s largest private radiology practice, founded in 1963, proved irresistible. All of the ingredients for success were well established in the 40-member group, which owns and operates six outpatient imaging centers throughout Greater Hartford County and maintains professional service agreements at four local hospitals. Grossman’s charge is to fine-tune, team build, and embark on a strategy of controlled growth and diversification.

ImagingBiz.com: We are in a time of extreme tumult in medicine and radiology in specific. Is Jefferson Radiology in a contraction mode, an expansion mode, or preserving the status quo?

GROSSMAN: Jefferson Radiology is the largest private-practice diagnostic and interventional radiology group and the largest provider of hospital radiology services in Connecticut. There is significant opportunity in the marketplace and we are in what I would call a managed growth mode. We are exploring many opportunities for expansion, and we want to be positioned to take on those opportunities while, at the same time, maintaining proper physician staffing.

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Gadolinium and You:
Why Imaging Centers Should Be Concerned

Emanuel Kanal, MD

The connection between gadolinium and the disease known as nephrogenic fibrosis syndrome (NFS) presents an urgent and immediate reason for imaging centers to amend MR policies, procedures, and protocols.

A flurry of advisories from the FDA, the ACR’s Document for Safe MR Practices: 2007, reports in the peer-review literature, and aggressive activities on the part of the legal community, have put this troubling development front and center for all parties associated with medical imaging.

“To the best of my knowledge yes, imaging center cases have been reported,” says Emanual Kanal, MD, Director, MR Services, University of Pittsburgh Medical Center “I don’t think all of these patients are inpatients at all.”

NSF/NFD, first observed in 1997, causes thickening and hardening of the skin, usually in the extremities, and occurs in patients with underlying renal disease. It is a progressive, irreversible, and potentially fatal disease. Nearly all known cases of the disease have occurred in patients with at least one known exposure to gadolinium within a few days to months prior to developing the disease. But experts still do not know why some patients develop NSF, or how to prevent NSF from occurring.

Nonetheless, the first lawsuit pertaining to NSF and gadolinium was filed in Cleveland by law firm Spagenberg, Shibley & Liber on behalf of a retired Cleveland restaurant supplier who claims he contracted NSF from an MRI contrast agent. Other law firms are actively soliciting NSF patients. It is time for imaging centers to batten down the hatches and implement specific policies and procedures.

New Paradigm for Patients with Underlying Kidney Disease

The appearance of an association between gadolinium and nephrogenic fibrosis syndrome (NFS) brings the issue of contrast-induced nephropathy (CIN) into sharper focus for imaging centers. Many patients at risk for CIN were automatically referred for MRI. However, the appearance of NFS in patients who had received high doses of gadolinium has complicated the management of patients requiring imaging who present with underlying kidney disease.

The May issue of Imaging Economics contains a supplement dedicated to the management of contrast-induced nephropathy, “CIN: Anticipate, Manage, Prevent,” which carries 1.25 AMA PRA Category Credits. The supplement includes articles on prevalence, identifying high-risk patients, prevention strategies, and contrast choice.

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CME Activity

The Gores Group, LLC, came out of left field to snap up HealthSouth Corporation’s entire portfolio of 54 imaging centers with a $47.5 million offer. A private equity firm with holdings in telecommunications, business services, and manufacturing, Gores’ HealthSouth acquisition represents a new platform for the company, soon to be one of the industry’s biggest players. The transaction is anticipated to be complete by the end of June or early in the third quarter of 2007, and is subject to customary closing conditions, including regulatory approval. With considerable capital behind it, Gores is likely to be a more formidable competitor that HealthSouth.

Caption: Since this data was released, Radnet purchased Radiologix to become the industry’s largest player, with 129 centers. HealthSouth also divested nearly 30 centers before selling its 54-center diagnostic division to Gores Group. Adapted from the Diagnostic Imaging Center Market Report: 2006 Edition; Top 25 Diagnostic Imaging Center Chains.

“We are opportunistic buyers here,” said Ryan Wald, managing director, The Gores Group, Los Angeles, Calif, told ImagingBiz.com. “We have focused historically on corporate carve-outs. We like businesses where we can add some operational value.”

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Emerging from the two addresses delivered by noted health informaticist Brent James, MD, at the last meeting of the Radiological Society of North America (RSNA), attendees could not help but ask the above question. If ever there was a case for managing the utilization of care, that time is now.

James is executive director, Institute for Health Care Delivery Research, and vice president, Medical Research and Continuing Medical Education, Intermountain Health Care, and has spent the past 20 years championing the cause of standardization of clinical care through data collection and analysis. It is James belief that much of the care being delivered today is non-value-added, particularly vexing considering the financial viability—or lack thereof—of the Medicare program.

Citing Treasury Department numbers, James noted that federal spending on Medicare has risen from zero of the federal budget prior to 1966 to 10% in 1986 and 19% in 2006. In laying out the impending crisis, James drew heavily on the work of David M. Walker, the Comptroller General of the United States, who has used his term to travel the country and sound the alarm. “When you think about it, he’s the CFO of the United States,” noted James. “His main his main focus is on what he calls implicit exposures. These are promises the United States has made to citizens currently alive, beyond what current levels of taxation will support with inflation and further growth of taxation built in. These are unfunded liabilities for the United States government.” Our $46 trillion in implicit exposures adds up to $150,000 for every man, woman, and child currently alive and living in the United States.

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Amended Complaint Filed in Illinois Lease Case: Referring Physicians Still AWOL

An amended complaint filed by the Illinois Attorney General in the per-click leasing complaint, initially filed by a whistleblower last year, parsed out a few more legal entities that operated the 19 named imaging centers, but failed to name any of the referring physicians in the complaint.

“One thing that is pretty clear is that no individual physician groups were added as defendants,” noted W. Kenneth Davis, Jr., JD, partner, Katten Muchin Rosenman LLP, Chicago. “There has been some speculation about whether any of the leasing groups would be added as defendants, and it’s pretty apparent from the complaint that they were not added. On the one hand the whistleblower here (and the AG by joining) has chosen to only focus on one set of parties in what are almost by definition two-party transactions. On the other hand, despite allegations that kickbacks have occurred, the whistleblower and the AG have only focused on the alleged payor, if you will, of the kickbacks. They have not focused on the alleged recipient of the kickback, i.e., the leasing physician groups.”

Davis made the following observations about the amended complaint:

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Executive Suite

Weems Nominated to Head CMS
President Bush has nominated Kerry N. Weems, Department of Health and Human Services deputy chief of staff for the top position at CMS. Leslie Norwalk, acting administrator, reportedly took herself out of the running.

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>> Submit Executive Personnel Changes Here >>