THE BIG PICTURE

The Tortoise and the Stack Burner
By Curtis Kauffman-Pickelle

You know the tale. In the end, the steady pace of the tortoise won out over the supreme confidence and sheer speed of the hare; the hare simply did not value the focus, commitment, skill set, and tenacity exhibited by the tortoise. There are lots of lessons to be learned from this story, and over the years, most of us have learned how to apply at least some of them in our careers.

In radiology practices around the country, however, there is one lesson that still seems elusive. Among the many questions that I am asked about productivity and stack time is the consistent dilemma of how to value off-stack time. In other words, when partners in the group step up and perform functions other than meeting the required daily RVU count, how are these functions—this time away from the so-called real work—valued?

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Finding Value in Imaging-center Valuations
By Elliott Jeter, CFA, CPA/ABV, and Sally Inman

After unprecedented growth over the past two decades, freestanding imaging providers have found the past few years challenging. Increased regulatory oversight, negative reimbursement changes, tighter access to financing, and general business uncertainty have all taken their toll, and pessimism within the industry runs rampant. In response, some freestanding imaging providers have consolidated, downsized, restructured, or closed—trends that have undoubtedly altered the competitive landscape in many saturated markets.

With all of the pessimism in the freestanding imaging market today, it is more important than ever to ensure that your valuation consultant considers all factors, positive and negative, when performing an analysis of fair market value.

Most imaging-center transactions must have the support of an independent opinion of fair market value. Understandably, many business-valuation experts who perform imaging-center valuations fail to consider the freestanding imaging industry’s many positive dynamics adequately, and they therefore undervalue the business. With the negative headlines and heightened uncertainty, it is too easy to focus on these concerns at the expense of the more complex (and less obvious) factors that the analysis should also consider.

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Comparative-effectiveness Research and Imaging: Insights and Ambitions
By Cheryl Proval

In addition to extending coverage to an estimated 31 million US residents, the recently passed HR 3590, the Patient Protection and Affordable Care Act, has ensured a future for comparative-effectiveness research (CER) by legislating funding, at $500 million per year, for the indefinite future. The stimulus bill launched the CER initiative with seed funding and required the Institute of Medicine (IOM) to identify a list of high-priority CER topics. Most recently, an article by VanLare et al¹ described a five-step process for determining how to translate those 100 priorities into a portfolio of specific research projects (see box).

ImagingBiz spoke with one of the authors, Harold C. Sox, MD, cochair of the IOM committee to set national priorities for CER, about its role in decision making, its potential use in answering imaging questions, and the recent controversial mammography recommendations of the US Preventive Services Task Force (USPSTF), which he chaired in the early 1990s.

"Anybody who is making coverage decisions, as well as physicians and patients, is going to benefit from CER because it's going to help to make better decisions. Better evidence should mean better decisions."

—Harold C. Sox, MD, chair of the IOM committee to set national priorities for comparative-effectiveness research

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Crystal Ball: Toward True Enterprise Image Management
By Cat Vasko

As the potential role of informatics in transforming health care gains national attention, how are IT tools for imaging and image management evolving to improve clinical efficiency and bolster quality of care? ImagingBiz spoke with Aaron Waitz, vice president of product development for FUJIFILM Medical Systems USA, Stamford, Connecticut, on the future of imaging informatics and the Fujifilm Synapse® product line.

ImagingBiz: As the newly appointed VP of product development, what would you say is your driving goal/vision for Fujifilm product development?

Waitz: What I've been driving home with our development teams is the need to focus on our mission: producing innovative, high quality products that exceed our customers' expectations. While some might hear this and think it's just a cliché, to me adherence to it will be fundamental to our future success. What we believe will make a high quality product is continuing to exploit our native Web-based architecture into new applications. We have already integrated our PACS, RIS and cardiovascular applications; continued concentration on taking advantage of the synergies in our infrastructure across the different modalities and clinical specialties we serve, while also providing unique user experiences for clinicians via the toolsets that aid their workflow, will be key.

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Tapping the Rural Market: A User's Guide
By Elaine Sanchez

The emergence of PACS has given practices a chance to expand their business and boost revenue by tapping the rural hospital market. Before adding clients to their own networks, however, groups must pay attention to projected costs and potential profits, according to Gabe Graham, CPA, a financial consultant at Medical Management Professionals Inc (MMP), Atlanta, Georgia.

Graham assisted Diagnostic Imaging Associates (DIA), Tulsa, Oklahoma, through the process of extending services to rural hospitals; along the way, he helped analyze hospital reimbursement and contracts to ensure profitability, while the group was able to leverage downtime in the workflow from its existing hospital partner.

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Bariatric MRI: Challenges and Work-arounds
By Rich Smith

ThedaCare is Northeastern Wisconsin's largest community-owned health system; its numerous radiology units strive to provide the highest-quality imaging to attract new referrals while simultaneously retaining hard-won existing business. Until relatively recently, however, performing MRI exams for patients weighing more than 300 pounds was a problem.

Larger patients were often too big to fit into the bore of the organization's conventional high-field MRI scanners, and when they did fit, the cramped confines could trigger bouts of claustrophobia. Depending on the intensity of anxiety at feeling entombed, these patients would squirm or try to get out of the scanner.

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Radisphere National Radiology Group Launches
By Cat Vasko

To further its aim of extending subspecialty radiology services to community hospitals, Franklin & Seidelmann Subspecialty Radiology, Beachwood, Ohio, recently announced the creation of a new company called Radisphere National Radiology Group. True to its name, the group will have a national scope, with the ability to provide radiology services to community hospitals from coast to coast.

"We've always struggled with the term teleradiology," Scott Seidelmann, president and CEO of Franklin & Seidelmann, explains. "Teleradiology is really a medium—a use of technology to migrate information and results from point A to point B. We are a radiology group: We obtain hospital contracts, and we employ radiologists. We just happen to use technology quite a bit to do what we do better."

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PUBLISHER
Curtis Kauffman-Pickelle

EDITORIAL DIRECTOR
Cheryl Proval

EDITOR
Cat Vasko

ADVERTISING DIRECTOR
Sharon Fitzgerald

PRODUCTION COORDINATOR
Jean Lavich

TECHNICAL EDITOR
Kris Kyes

WEB MASTER
Robert Elmquist

CONTRIBUTING WRITERS
George Wiley
Julie Ross
Rich Smith

Health-care Reform: Imaging-related Provisions
The health-reform bill was signed into law on March 23; it contains several imaging-related provisions, including an increase in Medicare's assumed equipment-utilization rate from 62.5% to 75% for equipment costing $1 million or more, an increase in the contiguous–body-part discount rate from 25% to 50% in 2011, new provisions for self-referral disclosure, exclusion of the US Preventive Services Task Force's mammography screening guidelines as a basis for coverage decisions, and more.

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Scientist Claims FDA Ignored Imaging-safety Concerns
In the wake of the FDA's late-March hearing on dose and safety in imaging, former FDA scientist Julian Nicholas came forward, claiming that his job was eliminated after he expressed concerns about the risk of radiation exposure from CT imaging. "Scientific and regulatory review process for medical devices was being distorted by managers who were not following the laws," Nicholas says.

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Early Imaging Correlates With Shorter Hospital Stays
A study in the most recent issue of Journal of the American College of Radiology: JACR finds that patients imaged shortly after hospital admission experienced a reduced length of stay. The retrospective study of 33,226 admissions to an urban tertiary-care hospital in 2005 identifies 10,005 admissions that included an advanced imaging study; for this group, the mean length of stay was found to be considerably shorter for those imaged before or during the first day of the hospital stay.

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ONC Awards $60 Million in Health IT Grants
The Office of the National Coordinator for Health Information Technology has awarded $60 million in research grants to the Mayo Clinic, Harvard University, the University of Texas Health Science Center at Houston, and the University of Illinois at Urbana—Champaign. Each institution's research projects will identify short- and long-term solutions to address challenges such as health IT security and promoting the secondary use data from the electronic health record while maintaining privacy and security.

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APRIL

19th Annual MRMS Educational Conference
Sponsored by the Magnetic Resonance Managers Society

April 24–28
Omni La Mansion del Rio, San Antonio, Texas

Topics run the gamut of MRI management, from reducing avoidable errors and infection control to accreditation and appropriateness, in addition to motivational sessions.

[Register]

MAY

International Symposium on Multidetector Row CT
Sponsored by the International Society for Computed Tomography

May 18–21
Hyatt Regency, San Francisco, California

The 12th annual symposium will feature focused 10-minute lectures from 65 international speakers; the conference will also include the eighth annual Workstation Face-Off.

[Register]

2010 Radiology Summit
Sponsored by the RBMA

May 23–26
The Broadmoor, Colorado Springs, Colorado

RBMA's annual meeting of radiology business professionals will feature extensive educational sessions presented by industry leaders, allowing attendees to share business challenges and solutions.

[Register]

PRESIDENT/CEO
Curtis Kauffman-Pickelle

VP, PUBLISHING
Cheryl Proval