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THE BIG PICTURE
Radiology's Tough Love
By Curtis Kauffman-Pickelle
Last month, I discussed the need (and demand) for a culture and ethos of customer service within medical imaging practices, departments, and centers. Apparently hitting a bit of a nerve, I received some rather interesting responses that point out a significant disconnect between this ideal and the current reality, based on a certain anthropology that exists within the ranks of many radiology groups.
A typical response, paraphrased, went something like this: "Curtis, we get it, but how can we have a commitment to customer service when our radiologists don't care about the customer, arrive at work late, leave early, never even bother to say thank you to the referring physicians, and generally seem to be concerned only with their time off or their incomes?"
It sounds like there may be a disconnect here. It's an old refrain: do as a say, not as I do.
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2009 MedPAC Report:
A New Threat to High-quality Care
By Paul S. Viviano
In 1997, Congress created the Medicare Payment Advisory Commission (MedPAC) to provide recommendations regarding health care policy and reimbursement with respect to the Medicare program. Since then, MedPAC has performed an important and useful role, collecting and analyzing data and trends affecting the means and methods by which the US government provides for the health care of our senior citizens.
"In its own report, even MedPAC acknowledged that there is no empirical evidence about the actual use of high-cost diagnostic equipment and that it had not conducted any broad-based study to support its recommendation. Instead, MedPAC defended its recommendation purely on policy grounds, arguing that such an increase would significantly deter the proliferation of such equipment."
While sometimes controversial, and often opposed by various health care groups, MedPAC's recommendations have generally been characterized by reliance on credible empirical evidence and a balancing of important policy objectives, including access to care in rural areas. Unfortunately, MedPAC's February 2009 Medicare report¹ (which includes a recommendation that Medicare's formula for nonhospital MRI, CT, and PET/CT reimbursement be modified to increase the equipment-use factor from 50% to 90%) departs from this tradition.
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Visage Imaging CEO David Chambers:
On the Future of Health Care IT
By Cheryl Proval
Earlier this year, Pro Medicus Ltd., the Australia-based RIS provider, acquired Visage Imaging. ImagingBiz.com spoke with David Chambers, CEO of Pro Medicus Ltd. and Visage Imaging on the history of the company, details of the acquisition, and the health care IT landscape in the land down under.
"Health care (along with many facets of the delivery of that care) is shifting away from hospitals over time. This is why the golden chalice of health care informatics is to provide solutions that can span, and interoperate across, the patient's continuum of care."
—David Chambers
ImagingBiz: Tell us about the history of Pro Medicus. Where did the company begin, and how did it get to be the diversified informatics company that it is today?
Chambers: Pro Medicus started in 1984 with a medical practice-management system that has evolved into a sophisticated RIS servicing more than 70% of the Australian private-radiology market. The year 2000 was a turning point for the company. It launched an Internet-based e-health network that now services over 27,000 primary care physicians and listed the company on the Australian Stock Exchange, where we currently have a market capitalization of approximately $75 million (Australian).
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Grassroots Activism 101
By Rich Smith
No one is quite sure when the word draconian came to be the semiofficial modifier of the word cuts, when used in conjunction with the noun DRA. Mark Newton recalls hearing it often during the campaign to convince federal lawmakers that their Medicare cost-saving bill was a disaster in the making for radiology.
"From the government's perspective, the DRA was a success—the cuts saved 12.7% on Medicare expenditures, and yet patient access to imaging services did not suffer. You take that, along with Medicare's growing need for more control over spending, and you have plenty of incentive for Congress to want to contemplate further cuts."
—Mark Newton
Newton, CFO of a radiology group in Hudson Valley, New York, was a local leader in the effort to derail the DRA, and he worked hard at encouraging others to speak up, be heard, and make a difference. Ultimately, the forces favoring full implementation of the DRA prevailed over grassroots coalitions like Newton's; his consisted of 40 other New York radiology practices and their thousands of patients, all opposed to the imaging-antagonistic mandates spawned in the nation's capital.
Their efforts, however, were not in vain, for they proved instrumental in protecting imaging against additional proposed financial hits. The lesson: What Newton accomplished, anyone can.
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In the Navy:
The DoD and the Future of PACS
By Cat Vasko
The US Navy deployed its first PACS—a military-specified system with limited functionality—in 1996. Since then, the Navy has operated multiple PACS from a variety of vendors, all selected through a contracting process monitored by the US Department of Defense (DoD). "Our purchasing process enables us always to select the best of breed," Edwin Doorn, logistics management specialist with Naval Medical Logistics Command, Fort Detrick, Frederick, Maryland, explains. "We're not locked into using a single product. We can shop for what works best for our needs."
Doorn should know: He's one of the people charged with selecting the best PACS for a given naval facility, a task made no easier by the rigorous security requirements of the DoD. In 2007, the Navy deployed its first Synapse PACS from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut, at a naval hospital in the Pacific; soon, the system was installed at seven sites, including Naval Medical Center Portsmouth in Virginia, where it replaced a slow-running legacy PACS. "It can be challenging to install anything from a new vendor in a DoD facility," Doorn notes. "We have an extremely stringent network, and FUJIFILM was able to meet our security needs. That was the primary driver behind our decision making at the time."
Doorn explains that this is a key differentiator in his health system, where the need for data security applies as strictly to DoD communications as it does to medical equipment. "We need to be sure there are no vulnerabilities in the technology we put in our hospitals, and that can be difficult because medical equipment, by its nature, is vulnerable," he says. "When we started making ourselves network capable, that portion of security wasn't really examined. Now, the DoD is the driving force in making sure these systems are secure before they become a part of our network."
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Managing Errors in Demographic/Clinical Information:
Using Tracking Mechanisms
By James A. Kieffer
All insurance accounts fall into one of two groups: full resolution (at negotiated fees, where the credits only consist of cash, contract adjustment, and probable bad debt, if any patient balance cannot be collected) or full write-off (where the practice did not comply with a payor-based rule).
Past ImagingBiz.com articles illustrate how billing systems should organize information on billed results. One article¹ focuses on reports that can reveal lost revenues attributed to payor rules and on the importance of developing compliance-based coding. A second article² deals with reports that a billing company should be able to provide to track the dictation patterns of practice members, for exams that can be either complete or limited, to determine whether all members are consistent in articulating clinical findings between the simple and complex cases.
There is a third component that a practice needs from its billing company or internal system. How does it manage exams that have missing or flawed demographic and/or clinical information that prevents the case from being billed?
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Accreditation and Radiology
By Kris Kyes
Accreditation is important to radiology providers not only in ensuring reimbursement eligibility and protecting turf, but in creating the opportunity to make needed operational changes, according to David M. Yousem, MD, MBA. Yousem, who is professor of radiology and director of neuroradiology at Johns Hopkins Medical Institutions, Baltimore, Maryland, is the co-editor of Radiology Business Practice: How to Succeed.¹ At the Economics of Diagnostic Imaging conference in Arlington, Virginia, he drew on that text to present "Credentialing, Accreditation, and Certification" on October 24, 2008.
In the accreditation portion of his presentation, he covered the need for site accreditation by the ACR for all radiology providers, and by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) for hospitals. Good standing with both state and federal regulatory agencies is one of that organization's requirements, which have focused on the quality and safety of health care since the organization was founded in 1951.
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Keeping Country Radiology Cool
By George Wiley
A rising tide lifts all boats, as the saying goes, and thanks to the hastening deployment of subspecialty teleradiology, some of the smallest imaging-department boats are riding high. This is good news for patients in rural areas, who can now stick with their local hospitals for their imaging needs. It's good news for those hospitals, too, because the subspecialty imaging they can now offer helps them run in the black.
 
Extending subspecialty service to rural areas is no trivial matter. According to the American Hospital Association (AHA), of the more than 5,700 hospitals in the United States in 2007, about 2,000 of them (35%) were classified as rural community hospitals. According to 2006 AHA data, approximately 54 million patients were served in these rural settings, including 9 million Medicare beneficiaries. Rural hospitals provide a critical component of US health care.
Syringa General Hospital
Grangeville, Idaho, is a town of about 4,000 people situated roughly 200 miles north of Boise. Syringa General Hospital is Grangeville's only hospital and, according to radiology manager Kyle Kellum, RT(R), serves an area within a radius of about 40 miles beyond the town.
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| SAVE THE DATE |
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Webinar: JUNE 18, 2009, 2 PM EST
Advanced Visualization:
Next Generation Architectures
Presented by: Keith Dreyer, DO, PhD
Associate Chairman of Radiology
Massachusetts General Hospital
Assistant Professor of Radiology
Harvard Medical School
Corporate Director
Partners HealthCare
Click here for details.
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| INFORMATION RESOURCES |
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Medicare Fraud Suit Filed Against MedQuest
US Attorney Edward Yarbrough's office filed suit against a Georgia-based diagnostic imaging company with 90 centers in 13 states, alleging Medicare fraud. MedQuest Associates, Alpharetta, is accused of submitting fraudulent Medicare claims between December 2002 and October 2006 from local BioImaging diagnostic clinics. The suit claims that MedQuest failed to have qualified on-site physicians monitoring tests in IV contrast media were administered to patients.
[Read More]
CNRU Reactor Shutdown Impedes US Medical-isotope Supply
On May 19, MDS Nordion announced that the Canadian National Research Universal reactor in Ontario will be shut down for a month to repair a heavy-water leak. The reactor is responsible for producing more than half of North America's supply of molybdenum Mo 99; the isotope is not produced commercially in the United States.
[Read More]
Cancer's Stem-cell Vulnerability Identified
The May issue of RSNA News reports that researchers at the Stanford University School of Medicine have identified a protective pathway that shields cancer stem cells from DNA damage. Blocking the pathway has been shown to make the stem cells more susceptible to radiation, offering one explanation as to why certain tumors are resistant, or become resistant, to chemotherapy and radiation.
[Read More]
Survey Reveals Impact of DRA on Radiology Practices
An article in the June issue of Journal of the American College of Radiology: JACR looks at the results of a 2007 survey of ACR members aimed at examining the impact of the DRA on practicing radiologists' incomes. The report indicates that following DRA implementation, practices were more likely to lay off staff members and cancel purchases of new imaging equipment than to reduce imaging services.
[Read More]
Report: IT Key to Revitalizing Health Care System
According to a report issued by The New England Healthcare Institute, a nonprofit health-policy group, implementation of health care IT is key to revitalizing the country's struggling primary care model. "Properly implemented, [health care IT] frees up physician time during visits, provides all members of the primary care team with timely access to patient information, and aids in the overall coordination of care," the report says. It also calls for the development of financial models that encourage adoption of these technologies.
[Read More]
Uninsured Population to Rise by 7 Million in 2010
A new University of California–San Diego study published online on May 28 by Health Affairs looks at the impact of the recession on the number of uninsured US residents. The report predicts that the uninsured population will increase by at least 6.9 million in the coming year. Furthermore, this estimate does not consider the direct effects of additional job losses, but these losses are likely to add millions of US residents to the total number of uninsured individuals.
[Read More]
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| COMING EVENTS |
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JUNE
2009 SNM Annual Meeting
Sponsored by the Society of Nuclear Medicine
June 13–17
Metro Toronto Convention Centre, Toronto, Ontario, Canada
This year's annual meeting of the Society of Nuclear Medicine will include expanded poster categories, an exhibitor show floor, and updated courses and sessions in eight tracks, ranging from basic science to nonradioactive molecular imaging. The conference will also feature a four-part educator's forum.
[Register]
2009 ANI Healthcare Finance Conference
Sponsored by the Healthcare Financial Management Association
June 14–17
Washington State Convention and Trade Center, Seattle, Washington
The Healthcare Financial Management Association's annual conference on health care finance will focus heavily on the current economic and health care climate, with numerous sessions on cost savings, efficiency, revenue, and capital strategies. This year's conference will also offer more provider case studies, from large health care systems to small community hospitals.
[Register]
AUGUST
AHRA 2009 Annual Meeting and Exposition
Sponsored by the Association for Medical Imaging Management
August 9–13
Mandalay Bay Hotel, Las Vegas
The Association for Medical Imaging Management's annual meeting will feature over 1,000 leaders in the imaging field, with dozens of sessions addressing management issues ranging from finance to operations. The AHRA Imaging Leadership Institute will also offer its Basic Management Skills Program at the conference.
[Register]
OCTOBER
2009 RBMA Fall Educational Conference
Sponsored by the RBMA
October 11–13
Sheraton Wild Horse Pass, Chandler, Arizona
[Read More]
Economics of Diagnostic Imaging 2009
Sponsored by ESI Educational Symposia
October 29–November 1
Ritz-Carlton Pentagon City, Arlington, Virginia
The 2009 Economics of Diagnostic Imaging meeting will focus on strategies for success in an uncertain economy, with reimbursement mechanisms, legal issues, pay for performance, and productivity measures among the topics to be discussed.
[Register]
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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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