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THE BIG PICTURE
To Read or Not to Read
By Curtis Kauffman-Pickelle
As Shakespeare's famous Prince of Denmark did, many radiologists I know struggle with choosing between two mutually exclusive paths to fulfillment. In Hamlet's case, the idea of honorable revenge was countered by fantasies of ending it all. While not as draconian, the choice for radiologists is nevertheless gut wrenching.
Should you continue to suffer the slings and arrows of life's outrageous fortune, which brought you the so-called opportunity to read imaging studies conducted increasingly by other specialists with their own newly purchased equipment?
Instead, do you stand on principle and ignore the path that leads inexorably to (at least short-term) financial security? It's a tough choice. Maybe you have kids in college with high tuition bills. Maybe you still have your own student loans to repay. Maybe you have simply become locked into a lifestyle that requires boatloads of cash to keep it going. In any case, walking away from lucrative reading contracts with doctors at the top of the self-referral food chain sounds easier than it might prove to be for many radiologists who would otherwise denounce the practice.
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2008 Update on Non-hospital-based Outpatient Medicare Reimbursement
By Kris Kyes
As part of GE Healthcare’s commitment to ongoing monitoring of the reimbursement situation, GE presented a Webcast on this topic on May 7, 2008. Called the 2008 Reimbursement Environment for OICs, the program was presented by Michael Becker, general manager, reimbursement, and John Schaeffler, manager, federal government relations, both of GE Healthcare.
 The hour-long Webcast covered 2008’s changes in outpatient imaging reimbursement; current threats to reimbursement, along with positive developments for some imaging applications; the Economic Stimulus Act’s benefits for imaging providers; and GE’s important work in imaging advocacy among payors, lawmakers, regulatory agencies, the medical community, and the public. (These reimbursement topics will be covered in greater depth at the 3rd Annual GE Healthcare Outpatient Imaging Center Conference in Washington, DC, July 23-25. Executives can access conference information and register at www.gehealthcare.com/registration.)
The presenters noted that imaging has become a target for spending cuts because of its own success, with the highest rate of growth in Medicare services per beneficiary, which it has sustained over the past several years. Because overutilization of imaging is often cited as a driver of this growth, payors are attempting to slow growth through aggressive measures.
These may take the form of utilization controls, including broader use of preauthorization, accreditation, and credentialing requirements; radiology benefit management services, which now affect two thirds of the privately insured; and, at the state level, a greater emphasis on self-referral and certificate-of-need regulations.
Commenting on the GE Webcast and the 2008 reimbursement environment, Gordon Baltzer of MEI Development Corp, Coral Springs, Fla, says:
"The evaluation of utilization assumptions underlying the establishment of reimbursement levels needs to be watched closely and is expected to increase, requiring imaging providers to operate closer to functional capacity to remain viable over the long term."
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Advanced Visualization:
A Do-it-yourself Approach
By George Wiley
With three-dimensional and other advanced visualization tools being used for a greater share of CT and other imaging studies, it is more important than ever for radiologists to have access to postprocessing software and equipment at the point of interpretation.
It is equally important for radiologists to develop and keep up their skills in using these tools. This means that hospitals and radiology practices must decide which kinds of advanced visualization tools they will put in place and where and how they will deploy them. Will they opt for enterprise-wide, single-vendor solutions, or will they choose best-of-breed approaches that might limit image distribution in favor of the ability of one vendor’s tool to perform a task particularly well?
At Albert Einstein Medical Center (AEMC) in Philadelphia, both approaches are used. Radiologists have access to advanced visualization tools embedded in their PACS software (Synapse from FUJIFILM) as well as a thin-client advanced visualization tool that has been interfaced with the PACS, tools powerful enough to handle the majority of the radiologist’s post processing needs. For other studies, like virtual colonoscopies, the hospital uses specialized post-processing tools.
Terence A.S. Matalon, MD, FACR, FSIR, is chair of the hospital’s department of radiology. He has been at AEMC for five years and has seen the hospital progress, he says, from largely film-based imaging to the PACS-based operation of today. Matalon says that about half of his time is spent administratively. During the other half, he’s a clinician who splits his time equally between interventional and diagnostic radiology, with the bulk of the diagnostic work involving CT. He recently shared his approach to volumetric imaging with ImagingBiz.com..
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Ten Trends, Five Years:
Predictions for Outpatient Imaging
By M. Shane Foreman
While long-term forecasts are always subject to error in a changing climate, today's market trends can provide strong, reliable indications of what to expect in the future. For outpatient imaging over the coming five years, ten ongoing trends, in particular, can be predicted based on the changes being seen in imaging now.
Trend one: Demand for outpatient imaging, and the resulting procedural volumes, will continue to increase.
Medicare outpatient imaging has increased for all modalities, exhibiting growth of more than 60% in some areas. CT and MRI volume growth have been exceptional, increasing at a rate of about 200% over the past 10 years. Economic factors have played a central role in imaging growth, with radiologists hoping to create a new revenue stream in the technical component, specialists attempting to augment their practices, and entrepreneurs trying to secure a historically strong return on investment.
Other influences have driven growth in imaging as well. They include new technology and expanding applications for it, the aging of the population, reimbursement expansion, increased consumerism, and the practice of defensive medicine.
Outpatient volumes will continue to increase as new applications add to demand. Among the volume-increasing applications and technologies are CT angiography, fusion imaging, 4D ultrasound, breast MRI, 3T MRI, functional imaging, molecular imaging, stand-up MRI, and dual-source CT.
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CCTA:
The Road to Acceptance
By Steve Smith
The advancement of imaging technology is invariably followed by a host of related challenges. Many of these challenges are questions raised by payors and answered by various medical associations in an effort to ensure a seamless transition from research and development to practical use. Coronary CT angiography (CCTA) has followed this well-worn path.
As one may expect, physicians were pleased with CCTA as another arrow in their treatment quivers, while payors were concerned about overutilization, specifically the use of CCTA as a screening tool for patients without symptoms or risk, or at low risk, for coronary-artery disease (CAD).
Appropriately, some medical organizations, including the American College of Cardiology, the ACR, and the Society of Cardiovascular Computed Tomography, have developed appropriateness criteria for CCTA that establish guidelines for proper use of this technology.
Selecting the Ideal Candidates
William Shea, MD, is the vice president and director of the 3D imaging lab and cardiac imaging for NightHawk Radiology, Couer d'Alene, Idaho. Shea has been involved in furthering the use of CCTA within appropriate guidelines. Shea recognizes that one of the important points in a higher-profile CCTA program is clearly identifying those patients who are candidates for the study.
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Chris Winkle:
Taking MedQuest In-House
By Cheryl Proval
Last August, the news that Novant Health, Inc, Winston-Salem, NC, had offered $45 million (with an additional performance-based contingency of $35 million and the assumption of all outstanding debt) for Alpharetta, Ga-based MedQuest set the outpatient imaging world abuzz. The deal, which closed in November, represented what many considered a premium price for MedQuest's 92 outpatient imaging centers and gave Novant a huge and immediate presence in outpatient imaging in the Southeast.
Two years earlier and fresh from an ordeal in which he brought long-term care provider Mariner Health Care, Atlanta, out of Chapter 11 and negotiated the successful sale of that company, Chris Winkle had come on as CEO to turn around MedQuest. The sale to Novant behind him and the Deficit Reduction Act (DRA) notwithstanding, Winkle is looking forward to enjoying life under the Novant umbrella.
"The Mariner turnaround was like living in dog years: the outcome was great, but it wasn't much fun on a day-to-day basis. Having seen the good, the bad, and the ugly in health care, it's really gratifying to have a solid organization such as Novant as our owner. You can see the big picture. They are the kind of organization that when they talk about a 10-year vision, you know they are going to live it and fulfill it."
— Chris Winkle, CEO, MedQuest
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The Role of CCTA in Primary Care
By Laurie M. Fisher
Primary care physicians are increasingly referring patients for coronary CT angiography (CCTA) to provide accurate diagnosis of coronary artery disease (CAD) and earlier disease management for their patients. Most practitioners recognize the benefits of CCTA for those who are at risk of coronary disease, as well as for patients who exhibit related symptoms. Still, clearing the way for these patients to take advantage of the advancing technology has been fraught with roadblocks.
Although the technology has been available for years, it wasn't until recently that CCTA was confirmed as providing more accurate information on the progression of coronary CAD than that provided by other diagnostic cardiology tests. In fact, a report in the American Journal of Cardiology for March 15, 2008, found that 64-slice CCTA has superior sensitivity and specificity in diagnosing obstructive CAD, compared with stress testing. "CCTA blew the doors off stress testing," David Dowe, MD, a radiologist at Atlantic Medical Imaging in Galloway, NJ, explains. "In the last month, we now have medical justification to provide to the insurance companies. CCTA should be the first-line test when examining patients expected to have CAD," he emphasizes.
Dowe reports that 60% of his radiology department's referrals for CCTA are from primary care physicians. About 10% come from cardiologists, while the remaining referrals are from hospitalists, nurse practitioners, and self-referrals. He estimated that in 2007, his department did 2,000 to 3,000 CCTAs, and he expects a growing demand for the diagnostic test. "It is an everyday exam," he says. "We are further along down the road; it is becoming mainstream."
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Proper Coding Delivers Big Results
By Dan L. Hiebert
Correct procedure coding is a primary, and pivotal, activity among providers and payors alike. Undercoded claims leave money on the table, while overcoded claims leave the practice exposed to financial risks, including potential accusations of fraud. If a practice spends too much time on coding, reporting, reviewing, scheduling, code approval, and amending reports, the practice will suffer as turnaround times increase and staffing expenses soar.
What if you knew, though, that more than 99% of your practice's claims were correctly coded? Would your practice bring in more money? Would you sleep better at night, knowing that you were not at risk for repayment and/or fraud accusations? How can correct coding be achieved while improving, not harming your practice or patient care? All of these questions provide a framework for establishing a simple, yet necessary, system for ongoing audit and review of your coding practices.
About a year ago, I introduced myself to ImagingBiz.com's readers as Inland Imaging's new chief reimbursement officer (CRO). As the company's CRO, I am responsible for maximizing the revenue delivery of our organization by implementing and managing billing and contract practices that accelerate and enhance billing services.
In that article, I discussed Inland Imaging's plans to improve coding through audits, education, and operational process improvements. What follows is an update on what we've done so far, challenges that we overcame, progress that we have made, and our plans for continued improvement.
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| INFORMATION RESOURCES |
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Medicare to Pilot Bundled Payments for Physician, Hospital Services
CMS will initiate a pilot program to test a bundled payment system in which providers will receive a single payment for both Medicare Part A and Medicare Part B services associated with certain surgical procedures, according to an article in CQ Healthbeat. Citing conflicting incentives, CMS will roll out the program in markets in four states—Colorado, Texas, Oklahoma, and New Mexico—beginning January 1, 2009. The program will affect 28 cardiac procedures and nine orthopedic procedures.
[Read more]
State Health Facts Update
Total state health care expenditures and cost-of-living variations are among the updated and added elements in the wide-ranging state-by-state database of health-related facts produced by the Kaiser Family Foundation. Demographics, health coverage, managed care, insurance, and Medicaid and Medicare are among the data modules.
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NOPR: Approve PET for All Cancer Patients
The National Oncologic PET Registry (NOPR) Working Group has requested formally that CMS approve reimbursement for PET for all oncologic indications, including the diagnosis, staging, and restaging/suspected recurrence of brain, cervical, ovarian, pancreatic, small-cell lung, and testicular cancer. NOPR's 18 months of data indicate that PET is associated with a 36.5% change in physicians' treatment decisions, spanning the full spectrum of potential oncologic uses of PET for the preceding conditions. At this time, the work group is not recommending that the data-collection process be terminated.
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Hospitals Expand Charity-care Threshold
Not-for-profit hospitals are lowering the threshold for charity care in preparation for new IRS reporting requirements scheduled to kick in for 2009 and 2010. Some hospitals have increased the qualifying earnings limit for free patient care from 100% of the poverty level previously to 400% now.
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| VENDOR RELATIONS |
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Mother's Day Mammograms From Fujifilm
As part of a national public-education campaign, and in celebration of Mother's Day, Fujifilm dispensed free mammograms from 8 AM to 2 PM at Hunter College, on the corner of 68th St and Lexington Ave in New York City.
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MedQuist Announces Tight Integration With iSite
MedQuist Inc, Mount Laurel, NJ, has released an enhanced integration capability between SpeechQ for Radiology and Philips' iSite, enabling bidirectional control, messaging, and communications between PACS and speech-recognition software, as well as streamlined login and improved workflow.
[Read More]
Nuance Reintroduces RadCube
Nuance Communications, Burlington, Mass, will reintroduce RadCube, a Web-based business-intelligence tool acquired with its recent purchase of Commissure. The tool facilitates advanced data mining, analysis, and classification to drive forecasting, utilization management, quality assurance, and benchmarking.
[Read more]
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| COMING EVENTS |
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JULY
Billing Operations Management Seminar
Sponsored by the Radiology Business Management Association
July 14–15
Hyatt Regency Tamaya Resort & Spa, Santa Ana Pueblo, New Mexico
Topics include preparing for the coming high-deductible environment, managing denials, corporate integrity agreements, billing self audits, detecting the silent PPO, and a Medicare update.
[Register]
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, PhD.
[Register]
AHRA Annual Meeting and Exposition
Sponsored by the American Healthcare Radiology Administrators
July 27–31
Colorado Convention Center, Denver
The premier educational and networking meeting for hospital radiology administrators features sessions on capital acquisition, innovative physician ventures, budgeting, calculating ROI, legal issues, revenue-cycle management, point-of-service collections, and much more.
[Register]
Process Improvement and Business Excellence in Healthcare
Sponsored by World Congress
July 30–August 1
Chicago
Hospitals, health systems, insurers, and medical practices will convene to discuss innovations in continuous quality improvement, including Lean, Six Sigma, Malcolm Baldridge, and other methodologies. [Register] |
| POSITION AVAILABLE |
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Executive Director
Oregon Advanced Imaging
The executive director reports to the board of directors of OAI and has overall responsibility for all aspects of business operations for three imaging centers in southern Oregon. Qualifications include a BS degree in related field (MBA/MHA preferred) and seven years' senior management experience in radiology or medical practice management.
Email résumés to cflinn@oaimaging.com or mail them to Carol Flinn, OAI, 881 O'Hare Pkwy, Medford, OR 97504. Visit OAI's Web site www.oaimaging.com for more information.
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| CORPORATE OFFICE |
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PRESIDENT/CEO
Curtis Kauffman-Pickelle
VP, PUBLISHING
Cheryl Proval
VP, CLIENT SERVICES
Steve Smith
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