Leadership's Secret Language
By Curtis Kauffman-Pickelle

Get Over the Guilt: Leverage Teleradiology to Improve Hospital Service
By Cat Vasko

Teleradiology has come a long way from its origins in the 1980s, when physicians would snap a photo of a film and transmit the image across telephone lines. Remote review, once a last-resort option, is now a commonplace service employed by hospitals and practices alike to handle stat cases at night or difficult subspecialty cases.

Berlin Particularly in the past year, however, nagging questions have arisen that might give those practices that use these services pause: Does a practice that avails itself of off-site coverage leave itself vulnerable to a Trojan-horse attack by the teleradiology provider? Will the practice be subjected to greater legal liability? Does it erode the service that a radiology practice provides the hospital?

In an interview with ImagingBiz.com, the president of one hospital-based radiology practice put the above concerns in context and maintained that a good teleradiology provider can, in fact, improve service to the hospital.

"If I got an involved or complex neuroradiological study, in the old days, I'd have to pack the films up and mail them to someone. Now I can send them in 3 minutes and get a consultation. When I do that, I'm offering a better service to my local hospital."

—Leonard Berlin, MD, FACR Chairman of Radiology, Rush North Shore Medical Center, Skokie, Ill

Canada's Number–one Imaging Provider Acquires American Radiology Services

CML HealthCare Income Fund, Mississauga, Ontario, has entered into a definitive agreement to acquire Baltimore-based American Radiology Services (ARS) for $151 million.

ARS operates 17 imaging centers in Maryland and Delaware and, in conjunction with the Johns Hopkins University-based 68-radiologist group American Radiology Associates (ARA), PC, Baltimore, performs 2.2 million imaging procedures annually. ARS also provides primary and secondary reading for 25 hospitals via teleradiology across seven states.

CML HealthCare is a leading provider of laboratory testing since 1971, and became Canada's largest provider of non–hospital–based imaging services when it acquired DC DiagnostiCare and its 146 clinics in five Canadian provinces.

Canadian companies are demonstrating a clear appetite for US imaging companies. Three years ago, Toronto-based investment firm Onex Corp acquired Minneapolis-based Centers for Diagnostic Imaging for $225 million, followed by its acquisition of Kodak Healthcare, Rochester, NY, now known as Carestream Health, in January 2007.

Part II: Bringing a Technology Plan of Action to a Successful Conclusion
This is the second article in a two-part series. Part II covers financing, CON strategy, marketing, and implementation.
By Cheryl Proval

Cheryl Proval Devising an imaging-center strategy and choosing a piece of technology take the imaging-center operator only halfway toward the successful conclusion of a technology plan of action: Further decisions and additional initiatives will be necessary before a piece of technology is successfully deployed.

An imaging-center operator must determine whether to lease or buy its equipment, although center operators in certificate-of-need (CON) states have an additional regulatory layer that can drive the overall technology strategy considerably. Because a new piece of technology is not only costly but, in many cases, represents an improvement in the community standard of care, a strategy to market the technology is also important.

Finally, imaging-center operators are well advised to draft an implementation strategy and assign someone to oversee the process, often given surprisingly short shrift.

When Disaster Means No Recovery
By George W. Wiley

Does turning to a PACS vendor for disaster archiving add certainty and ease to the recovery process when a mishap occurs and images must be retrieved or a PACS database must be reestablished? One New York hospital's radiology department thought so. The PACS administrator confirms that events have proved it right so far.

Hudson Valley Hospital Center (HVHC) in Cortland Manor, NY, is like many midsize hospitals that moved quickly to get into the digital age. In 2003, the hospital's radiology department installed its first PACS. Today, according to Erik Lundberg, manager of radiology and CT systems, the only film that the hospital processes is for a limited amount of mammography, and even that is about to go digital.

When HVHC chose its PACS, it was selected, in part, Lundberg says, because it was, at the time, one of the few Web-based offerings on the market (the hospital wanted a Web-based solution). Once the PACS was installed, administrators at the 128-bed hospital, which serves a string of Hudson River Valley towns about an hour's drive north of New York City, quickly turned their thoughts to disaster recovery. The World Trade Center attacks had left no illusions about invulnerability by the time the HVHC PACS was installed.

"We knew we wanted an off–site disaster recovery storage facility. We're pretty close to the Indian Point nuclear power plant as well as Manhattan."

—Erik Lundberg, HVHC PACS Administrator

A mishap or terror attack at Indian Point could eliminate or make inaccessible any on-site disaster archive, along with the original PACS data.

The Marketing Imperative: It's Not Your Father's Radiology
Each month, RadBrandBuilder will bring you interviews, opinions, and case histories designed to help you develop the business side of your practice through a discussion of how branding can become a central organizing principle for your organization.
By Steve Smith

Steve Smith Over time, the forces that make an industry strong and predictable will change. Some of the new developments will help it to prosper, while some will force it to exist and compete in areas that may seem uncomfortable. Often, however, that is only because the uncomfortable is also the new and unknown.

As a profession, radiology has recently been subjected to an evolution that is still in the early stages–an evolution that will force many practices to adopt strategies that were once unthinkable. The radiology practices that understand, early in this cycle, that conforming to the new business order is no longer an option will not only survive; they will thrive.

Perhaps the most difficult concept for radiologists to embrace is that of marketing. Promoting one's business is not second nature to most radiologists, some of whom are second–generation physicians and never saw their fathers or mothers marketing themselves. For these physicians, the thought of marketing–of actually promoting one–s talents and services, even to the point of personally calling on potential referrers–borders on the abhorrent.

Not every radiology business, however, is finding that marketing is a necessary evil. Some of the most progressive practices, in fact, are embracing the concept and reaping the rewards that accompany innovation.

Diversified Radiology: Pressing the Hospital Advantage

Diversified Radiology of Colorado, PC, has cast a long shadow in Denver since radiologist Kenneth Allen, MD, founded the practice in 1927. The group underwent a major growth period in the 1990s, when it merged with Metropolitan Radiology and Western Radiology, and today, the 60–radiologist practice serves 11 hospitals and has an ownership stake in eight outpatient imaging facilities, including one in the Fort Collins area. Practice CEO Christopher "Kip" McMillan began his career writing software for a medical billing company, subsequently joined DivRad as director of billing services, and took the helm as CEO in 2001. He is active in the Radiology Business Management Association and serves on the board as Western director. He agreed to discuss with ImagingBiz.com the leadership challenges and benefits associated with large practices.

ImagingBiz.com: For a radiology group as large as DivRad, what is the ideal balance between outpatient/office-based activities and a hospital-based practice?

UltraClinics: Same–day Cancer Diagnosis in Search of a Market
By George W. Wiley

Build a better mousetrap and they'll beat a path to your door—or will they?

Weinstein UltraClinics, Inc, is a company prepared to offer same–day interpretation of breast–biopsy tissue and, if needed, teleoncology consultation for women undergoing breast–cancer screening. Its processes and technologies have been patented and trademarked; they can be applied to other procedures, such as prostrate–cancer screening. UltraClinics has allied itself with large corporations like IBM and has even purchased its own pathology recruiting service to find staff for its proposed clinics.

For all this, more than a year after its unveiling, its actual operation is confined to two clinics affiliated with the University of Arizona. The patients that it serves number a handful per day. UltraClinics, for now, is an example of the inertia that can strike medical advances—not because the core ideas don't work, but because the health care delivery apparatus isn't designed or prepared to support them.

The irony is that while UltraClinics sits more or less motionless, its founder is almost certainly correct when he says that what the company offers is a model for how medicine will be practiced, perhaps in the near future.

College, 3D Lab Partner in Web–based Advanced Visualization Training

Falk The nation's first curriculum–based program for volumetric imaging began as do many collaborations between local businesses and technical colleges: a local start–up in search of a steady stream of skilled employees approached a local technical college.

Robert Falk, MD, founding manager director and chief medical officer for 3DR Laboratories, Louisville, Ky, says, "When we formed the company, our business plan called for, 5 years out, between 150 and 170 skilled technologists." 3DR supplies 24/7 access to postprocessing and image reconstruction by trained technologists. "From a selfish standpoint, we needed a supply chain of technologists who were highly trained and highly skilled to help us out at 3DR," Falk adds.

What turned this local success story into a nationwide educational opportunity was the convergence of new technology in the form of thin–client postprocessing, a compelling need, and a unique collaboration between education and commerce that resulted in the launch of the online 3DR Academy this month.

Practice Buyouts: What Should a Departing Physician Really Receive?
By James A. Kieffer, MBA

Kieffer The largest asset of a radiology practice is the cash value of its accounts receivable, and that valuation is prominent in the deferred–compensation package for a retiring member. The language in that section of the employment agreement generally stipulates a formula that is based on historic collection ratios taken from the practice's receivables system in periods just before the separation date of the physician.

Often, these formulae were developed many years ago and can become inaccurate as the reimbursement climate changes. There are many cases where conflicts occur over the valuation method because the departing member considers the result suspect.

It is no longer necessary to estimate the cash value of accounts receivable. The data points that today's receivables systems can produce enable a practice to pay out the exact contractual cash value over the months following separation.

Caution Ahead: Keep Your Eyes on the Road
By Joel White

White While driving a car, if you constantly look in the rearview mirror, it exponentially increases your chances of getting into a wreck.

The imaging industry was able to beat back more than a billion dollars' worth of cuts in Medicare in a bill that President Bush signed into law on December 30, 2007. Those cuts were originally included in a House–passed bill (HR 3162, the Children's Health and Medicare Protection Act) intended to slash payments to Medicare providers, including $1.2 billion for imaging services. Thanks to the efforts of dedicated advocates, however, the cuts were dropped at the last minute.

In the bill that Congress passed and that Bush signed, physicians were spared a 10% payment cut and granted a 0.5% positive update, but only for 6 months. Congress must once again revisit an even larger cut–of perhaps as much as 12%–by June or face the political wrath of the physician community.

Now, though, we need to change our perspective toward what might happen on the road ahead and the dangers that lurk in 2008 for advanced diagnostic imaging.

IMAGINGBIZ STAFF

PUBLISHER
Curtis Kauffman-Pickelle

EDITOR
Cheryl Proval

VP CLIENT SERVICES
Steve Smith

PRODUCTION COORDINATOR
Megan Runyon

TECHNICAL EDITOR
Kris Kyes

CONTRIBUTING WRITERS
Kris Kyes, Cat Vasko, George Wiley, Joel White

PLATINUM AFFILIATES

GOLD AFFILIATES

INFORMATION RESOURCES

Health Care Spending Tops $2.1 Trillion in 2006
A CMS report published in Health Affairs pegs health care spending in 2006 at $2.1 trillion, or $7,026 per person, accounting for 16% of the gross domestic product in 2006. The figure represents a 6.5% increase over spending in 2005.

[Washington Post]
[New York Times]

New CT Colonography Bill Introduced
Rep Barbara Cubin (R-Wyo) introduced in the House a bill that would make CT colonography reimbursable by Medicare as a colon–cancer screening procedure. HR 4879, the Virtual Screening for Cancer Act (VSCA) of 2007, would waive copayments for beneficiaries for CT colonography conducted within the first 6 months of the patient's becoming a beneficiary.

Physician Efficiency Debate: Time to Move On
It is time for physicians and payors to stop debating whether efficiency measures are effective and to begin collaborating on developing measures that can make a difference. In an article in the New England Journal of Medicine, Milstein and Lee outline the controversies and offer some suggestions.

Breast Care Company Expands Geographic Reach
Austin, Tex-based Solis Women's Health moved into the Phoenix market with the acquisition of BenOra Imaging, two breast centers founded by Avi BenOra, MD, in 1982. Three local Phoenix physicians will remain with the centers, which will be upgraded with digital equipment and incorporated into the Solis radiology information system. Solis also operates the Solis–Bertrand Breast Center in Greensboro, NC.

ACR Comments on Final Rule
The ACR has submitted comments on the 2008 Medicare Physician Fee Schedule Final Rule, urging Medicare to reconsider its denial of the eight new cardiac MRI codes and to publish its final rule for implementing the new reassignment rules and self–referral changes as early as possible in 2008.

New IRS Rules Require Nonprofits to Detail Free Care
New rules from the IRS will require more reporting detail from not–for–profit health care organizations on governance, executive pay, and the subsidized and free care they use to qualify for tax-exempt status. The new rules are part of a major revision of form 990, and will go into effect in 2008 and 2009.

VENDOR RELATIONS

InSight Rebrands Imaging Centers
Effective this month, InSight Health Services, Lake Forest, Calif, has changed the name of its imaging center business to InSight Imaging. The new name now appears on 22 sites in California, 10 sites in Arizona, and two sites in Nevada. The company operates 100 fixed–site imaging centers around the nation, none of which previously carried the InSight name, and 100 mobile diagnostic imaging units.

GE Healthcare Establishes IT School
GE Healthcare, Waukesha, Wis, has developed a vendor–neutral education program designed for biomedical and technical professionals. Called Essentials for Healthcare IT, the program explores the basics of connectivity and allows hands–on network development.

Fuji's ProSolv PACS Goes to Top of KLAS
ProSolv CardioVascular from FUJIFILM Medical Systems, Stamford, Conn, has earned the number–one ranking from KLAS in its 2007 Cardiology PACS Study. ProSolv ranked first in 26 of the 40 performance indicators.

[Read Report]

COMING EVENTS

February

PACS Training Seminars
Sponsored by OTech

Feb 4–5: PACS IT for Clinical People
Feb 6–9: PACS System Administration
Feb 11–12: HL7 Comprehensive Training
Feb 13–15: DICOM Comprehensive Training
Feb 18–20: PACS Advanced Troubleshooting
Homewood Suites, Grapevine, TX

A health care technology company, OTech specializes in IT training and consulting.

Managing a Radiology Practice from the Top: Physicians & Administrators Partner for Success '08
Sponsored by RBMA

February 22–23
San Francisco

A wide range of topics–from intergenerational conflict between physicians to running effective board meetings, practice governance, financial analysis, and more–will be covered in this 2-day session.

Health Information Management Systems Society Annual Conference & Exhibition
Sponsored by HIMSS

February 24–28
Orlando, FL

Former Sen Bill Frist, AOL founder Steve Case, Google CEO Eric Schmidt, and author Steven Levitt are among keynote speakers at the annual meeting devoted to health care informatics.

March

ACHE Congress on Healthcare Leadership

Sponsored by the American College of Healthcare Executives

March 10–13
Chicago

Networking and professional development are hallmarks of this meeting of health care leaders, with keynotes and sessions covering the spectrum of health care leadership, including ethics, quality, leadership, governance, safety, and reform.

Imaging100: The Executive Forum for Freestanding Diagnostic Imaging

March 16–18
Fairmont Scottsdale Princess, Scottsdale, AZ

This event is a place for senior–level business executives to network, exchange ideas, and develop relationships with other leaders in the diagnostic imaging industry. The educational sessions will cover topics including private equity, managing tiered networks, strategic planning, government regulation updates and forecasts, cancer-center physician joint ventures, mergers and acquisitions, CEO/CIO roundtables, and many more.

APRIL

The 5th Annual World Health Care Congress
Sponsored by

April 21–23
Marriott Wardman Park Hotel, Washington, DC

International gathering of health care executives addresses topics and trends driving the global health care industry, including evidence-based care, variability in care, and developing profitable clinics and hospitals.

JULY

Beyond Strategies: Best Practices for Excellence in Outpatient Imaging
Sponsored by GE Healthcare Beyond Program

July 23–25
JW Marriott Pennsylvania Avenue, Washington, DC

Top–notch keynote speakers and seminar leaders will present a variety of topics on trends in health care consumerism, merger and acquisition strategy, and marketing/demand management. Keynote speakers include Mark McClellan, MD; election analyst Charlie Cook; and futurist Jeff Goldsmith.