THE BIG PICTURE

Radiologist, Find Your Voice
By Curtis Kauffman-Pickelle

In a major front-page story, "The High Cost of Precision," in its Sunday, September 7, 2008 edition, the Los Angeles Times once again focused on the negative side of CT technology. Its opening statement positioned its argument by saying, "CT scans produce detailed views of internal organs, but they expose patients to significant radiation." The tone of the piece was made even clearer with two subsequent headlines: "Revolutionary scans come with a risk," and the real kicker, "CT scans can be good for doctors." Hint: Doctors make a ton of money from these scans, most of which are unnecessary.

There is, of course, nothing new about the fact that the media love to write stories about how doctors are making money with sophisticated imaging technologies. Both the New York Times and, now, the Los Angeles Times have focused in the past year on articles that underscore the outliers in the profession who are greedy and unscrupulous. As in any profession, these types of people are unfortunately part of the fabric, and it has been this way since the beginning of time. Examples are easily found, and they make for good newspaper copy.

In this particular case, the author of the article focuses on one aspect and byproduct of one of the most remarkable technologies ever invented. Without comparing the obvious risks associated, say, with surgeries that have been replaced by CT, the author outlines in great detail the number of CTs performed in a year; the fact that at 81 CT scanners per million people, the United States has almost three times the average for the rest of the industrialized world; and the cumulative radiation dose of these scans (frightening levels of millisieverts).

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The Next Wave: Compliance With Medicare IDTF Standards Requires Ongoing Diligence
By Scott Garrett

To say that the health care regulatory environment has been active over the past two years would be an understatement. The focus of this article is Medicare: the primary payor for health care services in this country and, often, the standard by which other payors establish their payment rules. Revisions to Medicare regulations often foretell what can be expected from other payors.

In July 2008, CMS issued proposed changes to the IDTF standards¹ (proposed rules) that, if finalized as presented, will change the business environment for all nonhospital-based outpatient imaging providers. Couple this with impending accreditation and physician/technologist qualification requirements under the Medicare Improvements for Patients and Providers Act² enacted in July 2008, and the stage is set for significant regulatory changes in the imaging industry. While other regulatory pressures exist at federal and state levels, Medicare may be the most significant regulatory force that diagnostic imaging faces in today's health care environment.

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The Dynamics of Reimbursement and High-quality Care
By Kris Kyes

Access to high-quality patient care is a cornerstone of customer-focused service delivery, Michael A. Silver, PhD, says. In turn, that goal is supported by technology that enhances performance and allows the imaging provider to do more with less. Part of making less go further is maximizing reimbursement through better management, he adds, ensuring that the work performed yields as much as it should. Silver, vice president of Sg2 (a health care research, consulting, and education company based in Skokie, Ill), presented The Outpatient Imaging Market: 2008 Market Update at Beyond™, the Third Annual GE Healthcare Outpatient Imaging Center Conference, in Washington, DC, on July 24, 2008.

In the current environment, health care policy decisions are driven less by clinical considerations and more by political and economic factors, especially as the payment system for health care in the United States becomes less workable, Silver observes. Payors, regulators, and some lawmakers are attempting to resolve distinct issues, rather than address underlying causes, and too few politicians understand the issues. With the subprime mortgage crisis negatively affecting access to capital and the cost of credit, it is little wonder, Silver says, that market pressures are being heavily felt by all imaging providers, yet rising consumer expectations demand attention to performance and customer service.

What is required, Silver advises, is a keen attention to margin and sophisticated management expertise.

"In the near future, the most important ingredient for profitability and survival will be management skills. Just like any other business has to manage margins, outpatient imaging and even imaging in the hospital is going to have to learn to manage its margins."

—Michael A. Silver, PhD,
Sg2, Skokie, Ill

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Increasing CT Productivity: Good for Patients, Referring Physicians, and the Bottom Line
By Giles Boland, MD

CT has become indispensable tool for physicians to use in diagnosing and managing a vast array of medical conditions. The use of CT to aid triage of patients in emergency departments is now routine. Most patients with cancer are diagnosed and monitored by CT. Even many benign diseases are best diagnosed and monitored using CT. In short, referring physicians are demanding more and more CT as they continue to see increasing value from exams performed using newer and faster machines, combined with innovative protocols that expedite the diagnostic process.

The success of CT, however, has come with a price. Many radiology departments are struggling to keep up with the increasing demand, yet patients and referring physicians expect, and even demand, that requested scans be performed quickly. Any wait for appointments can delay an important diagnosis, and both patients and referring physicians may choose to be scanned elsewhere if they can obtain an earlier appointment. Meanwhile, CT has become highly profitable, and any loss of patient volume, either due to poor productivity or because of loss of market share, can have a significant negative effect on the organization's bottom line. The net sum of all these pressures is that radiology managers are expected to provide rapid access to CT for referred patients and, in turn, increase CT capacity.

A frequent initial response to the demand for increased capacity is to purchase new equipment. While this ultimately may be necessary, invariably, many CT machines are not operating at optimal capacity. Too often, managers purchase additional CT equipment before full capacity has been realized, resulting in an unnecessary financial burden to many cash-strapped health care facilities. A more suitable approach would be to re-evaluate the existing workflow and operations critically to look for opportunities to increase capacity without resorting to purchasing new equipment. This makes financial sense, given the expense of the equipment, its requirements for additional space and staff, and the competition from other capital requests within health care facilities.

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Palm Beach Radiology Institute: Digital Out of the Box
By George Wiley

At Palm Beach Radiology Institute, operated by Palm Beach Radiology and Imaging Associates (PBRIA), there is no film, there never has been film, and no one expects ever to see film. When the outpatient imaging center opened a year ago, it was already an all-digital environment, built from the ground up to accommodate a digital infrastructure and a paperless workflow.

The patient accesses the digital file from the RIS and verifies the information by signing a signature pad; the RIS routes the ordered exam to the modality; the patient is escorted to the exam room, where the images are acquired and sent to the PACS; when the study appears on the worklist, the radiologist interprets it and dictates the report, which is saved to the RIS; a remote transcriptionist transcribes in real time into the RIS; and within half an hour of the images hitting the PACS, reports are automatically faxed or emailed to the referrer from the RIS.

"I would estimate it is 30% to 40% more efficient than a nondigital environment."

—Scott Studdard, IT manager,
Palm Beach Radiology Institute, North Palm Beach, Fla

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NightHawk Offers Model for QA
By George Wiley

It's easy to let quality assurance (QA) slip into a lip-service category, but that is something that a nighttime stat-reading teleradiology service can't afford to do—particularly if it is an industry leader like NightHawk Radiology Services. Dionne Watts, quality-assurance supervisor, says "QA for teleradiology is important because the client facility doesn't know our radiologists. They like to see how good we are. They don't personally see us on a day-to-day basis, so there is a trust factor that takes a lot longer to build. QA is a part of that."

Watts, an Australian who now works at NightHawk headquarters in Coeur d'Alene, Idaho, says that NightHawk put its QA program together eclectically, using Joint Commission requirements, ACR guidelines, and HIPAA regulations to frame its QA structure. NightHawk went further, though. The company researched QA at other big health care institutions and then added some ingenuity of its own to devise a program that met its special needs as a teleradiology provider. The result is a QA program that could be a model for other health care providers—and in fact, it often is. Watts calls it a "robust, reliable, and educational program."

NightHawk's QA program isn't simple. It can be quite complicated, but it's built on a simple framework: image interpretation errors or omissions are reported, reviewed, and studied for prevention next time.

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Role of the Center Manager: Driving Productivity by Nurturing Cooperation
By Cat Vasko

The team at OGH Imaging LLC, Grand Coteau, La, faces a daunting task every day: living up to the expectations of both OGH's hospital and physician investors while managing approximately 70 patient studies a day across eight modalities (MRI, 16-slice CT, ultrasound, DR, digital mammography, fluoroscopy, bone densitometry, and calcium scoring). Employing just six technologists—or seven, on the frequent occasions when David Rushing, center manager, steps in to help—OGH optimizes productivity, in a health care environment that's increasingly focused on the bottom line, by maximizing staff cooperation, even while minimizing staffing.

Rushing explains that OGH Imaging was born out of a 2003 partnership between Opelousas General Health System, Opelousas, La, and four radiologists wishing to separate from the hospital and begin their own ambulatory service center. The partners jointly invested in OGH Imaging, and the new business opened its doors in December 2005.

"The hospital initially missed the opportunity to invest jointly with some of its physicians, and when they saw their error, they used OGH Imaging as a way to reach out to the radiologists and invest with them."

—David Rushing, Manager,
OGH Imaging, Grand Coteau, La

Though the idea for a new outpatient imaging center came before the DRA was even on the books, by the time OGH Imaging opened, the radiology industry was quaking in the face of drastically reduced reimbursement. Some might have seen this as a sign that the business was doomed from the start, but to Rushing, it was a fortuitous opportunity. His team would learn to operate in a worst-case scenario, and things could only improve from there.

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Consumer-driven Health Care: Dealing With the Impact on the Physician Revenue Cycle
By Terri Fischer, CMPE, CPC, CMC

The health care industry will be facing significant changes in the future, and a medical practice's success is becoming increasingly linked to its revenue cycle. Reduced reimbursement from payors, along with changes in third-party reimbursement, has significantly affected how medical practices need to deal with the revenue cycle for their practices. Though consumer-driven health care is intended to provide a possible solution to rising health care costs, medical practices have already begun to feel the impact of this prominent trend.

The move toward consumer-driven health care is creating a world where patients must take more financial responsibility when it comes to managing their health, and this shift is forcing physicians to pay closer attention to the revenue cycle for their practices. As few as 20 years ago, when patients sought medical care, they understood that they were financially responsible for any services that were rendered. Insurance was only there to help reimburse them for their expenses. It was during these years that managed care developed nationally and became the standard reimbursement model, replacing the traditional model where patients carried much higher financial responsibility.

Under the managed care model, patients had little, if any, financial obligation relating to their health care. The return of financial responsibility to the patient under consumer-driven health care is a dramatic economic shift for medical practices and patients alike. This new emerging health care world—which includes catastrophic deductibles, increased coinsurance and copayment amounts, and gaps in coverage—is completely foreign to patients (consumers), as there exists an entire generation of health care consumers who have never had to bear the financial responsibility for their health care.

To help understand how best-performing practices were addressing this change in the revenue cycle, LarsonAllen teamed up with Gateway EDI, a national clearinghouse located in St. Louis, to conduct an extensive review of medical billing practices. The result of this joint research is the Physician Gold Standard Study, which offers insights into the success of top performers.

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PUBLISHER
Curtis Kauffman-Pickelle

EDITOR
Cheryl Proval

VP CLIENT SERVICES
Steve Smith

ADVERTISING DIRECTOR
Sharon Fitzgerald

PRODUCTION COORDINATOR
Megan Runyon

TECHNICAL EDITOR
Kris Kyes

WEB MASTER
Bob Stephens

CONTRIBUTING WRITERS
Scott Garrett
Kris Kyes
Giles Boland, MD
George Wiley
Cat Vasko
Terri Fischer, CMPE, CPC, CMC

Covering the Uninsured: Worth a 5% Increase in Health Spending?
A study by Hadley et al, published in Health Affairs, attempts to answer three questions. How much care do the uninsured receive? How much of their care is called uncompensated, and who actually pays for it? If the uninsured were covered, how much would the additional care cost? The authors postulate that the care would add 5% to US health care spending, or $122.6 billion.

[Read Aricle]

MGMA: ICD-10 Compliance Date Unworkable
The CMS call for an October 1, 2011, compliance date for the switch from ICD-9 to ICD-10 brought a swift negative response from The Medical Group Management Association, Englewood, Colo, which urged CMS to wait until the 5010 transaction standards are fully implemented and tested before implementing ICD-10. Not only does ICD-10 contain 10 times the number of codes in ICD-9, but the implementation of the new codes coincides with a HIPAA mandate to implement the next generation of electronic transactions (ANSI X12 version 5010), which many organizations believe needs to be implemented and fully vetted prior to the transition to the new code set.

[Read Posted Rule]

SIR Applauds UFE Recommendations
The Society of Interventional Radiology, Fairfax, Va, gave its thumbs-up to the recommendations of the American College of Obstetricians and Gynecologists (ACOG), which found uterine fibroid embolization (UFE) to be a safe and effective alternative to hysterectomy in the management of leiomyomas. ACOG listed UFE among level-A treatment options, meaning that the minimally invasive treatment is considered safe and effective based on long- and short-term outcomes data. Level A evidence is the highest grade possible. Currently, approximately 200,000 women annually have hysterectomies in the United States to treat symptomatic uterine fibroids.

[Read More]

New Imaging Informatics Job Board
The Society for Imaging Informatics in Medicine, Providence, RI, has launched a new online career center to help job seekers and employers connect. The new interactive job board features portals for job seekers and employers to post jobs, job criteria, and resumes. SIIM is waiving the $200 fee to post a job for institutional members during the month of September only. The service is free for job seekers.

[Career Center]

Web-based Cardiology PACS Version 4.0
FUJIFILM, Stamford, Conn, has announced the availability of ProSolv CardioVascular Version 4.0. The new software release features ProSolv as a Web-based application for full viewing and reporting via Web communications protocols, fully integrated with FUJIFILM's Synapse PACS. Version 4.0 features enhanced clinical tools such as pediatric echo reporting and a Z-score module, which enhance reporting efficiency; a new default echo-measurement analysis package; improvements to coronary-tree functionality; and resting ECG management, including Holter monitoring support.

[Read More]

Contrast Delivery With RFID
Covidien Imaging Solutions, Denver, has introduced a contrast-delivery system with radiofrequency identification (RFID) technology, designed to aid in patient safety by reducing the risk of medical error in radiology departments. The system combines Covidien's unit-dose, RFID-enabled Ultraject™ prefilled contrast syringes with its RFID-enabled Optivantage™ DH power injector to capture, store, and transmit data between the syringe and the injector using RFID transponders. Drug and exam protocols are automatically transferred onto printed labels for the patient record, eliminating the need for manual data entry.

[Read More]

3D Software Leverages Game Technology
FiatLux, Redmond, Wash, received FDA clearance to market Visualize™, a new image-processing software based on video-game technology. FiatLux software engineers have leveraged DirectX game programming protocols to create an application designed to run on off-the-shelf PCs and laptops with standard graphics cards. It can create vivid 3D and 2D reformatted images from CT and MRI scans. The company expects the $3,000 application to broaden the use of 3D/2D image postprocessing in neurosurgery, cardiology, and orthopedics.

[Read More]

OCTOBER

The Law: Black, White, or Shades of Gray?
Sponsored by the RBMA

October 15-17
Loews Philadelphia Hotel, Philadelphia

This two-day seminar will address the gray areas on the imaging regulatory front and instruct practices on avoiding risk and protecting the practice, members, and employees from litigation.

[Register]

Pathology Informatics & Diagnostic Imaging
Sponsored by DBI, UPMC, AACI, and API

October 19-23
Marriott City Center, Pittsburgh, PA

APIII is an annual conference designed for physicians, researchers, residents and graduate students interested in how informatics and imaging is transforming pathology and oncology. The theme this year is similarity and possible integration of pathology and radiology informatics.

[Register]

Economics of Diagnostic Imaging
Sponsored by ESI Educational Symposia

October 23-26
Arlington, VA

Sessions cover a wide variety of socioeconomic issues in radiology, including IDTFs, self-referral, reimbursement-management strategies, coronary CT angiography strategy, strategic planning, leadership, and legal issues.

[Register]

Revenue Cycle Strategies Conference
Sponsored by the Healthcare Financial Management Association

October 27-29
Las Vegas

This program combines hands-on peer workgroups with breakout sessions and general sessions. Topics include reducing recovery audit contractor risk, collection techniques, and resolving inconsistent reporting of health care claims data.

[Register]

NOVEMBER

Annual Meeting and Exhibition of the Radiological Society of North America
Sponsored by the RSNA

November 30-December 5
McCormick Place, Chicago

This year, the exhibits will span three halls, with a new layout intended to help attendees see more exhibits in less time. Hall D in the Lakeside Center will now hold exhibits, and the posters and education exhibits will move down a level, to Hall E. Nonetheless, comfortable shoes are recommended.

[Register]

APRIL

HIMSS 09 Annual Conference & Exhibition
Sponsored by the Healthcare Information and Management Systems Society

April 4-8, 2009
McCormick Place, Chicago

Next year, health care's largest IT event, the HIMSS meeting and exhibition, moves from February to April. The event features keynotes, education, and exhibits on a broad spectrum of health care IT topics.

[Register]

PRESIDENT/CEO
Curtis Kauffman-Pickelle

VP, PUBLISHING
Cheryl Proval

VP, CLIENT SERVICES
Steve Smith