THE BIG PICTURE

Radiology’s New Normal
By Curtis Kauffman-Pickelle

Don’t think that you are alone if the current uncertainty in virtually all aspects of medical imaging is driving you to distraction. Today’s radiology marketplace/profession has become increasingly complex, hypercompetitive, and extremely tense; the traditional relationships are in a constant state of flux. As much as I would like to tell you that this, too, shall pass, the fact of the matter is that this is the new normal. Constant change and unpredictability are here to stay.

The question is this: How can you take advantage of this new dynamic and use the chaos created by the accelerated pace of change to build an organization or practice that not only can withstand these uncertain times, but can rise to the top in a newly defined arena? To do that, today’s radiology leaders and hospital executives will need to have much more in their quiver than hope mixed with a measure of denial. I sense a lot of denial out there, and there still exists an eerie expectation that things will eventually return to the old normal.

That is just not going to happen.

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New Requirements for Documenting Imaging Orders
By Thomas W. Greeson, JD, Esq and Paul Pitts, JD, Esq

CMS published an interim final rule (with a comment period) on May 5, implementing several changes to the Medicare and Medicaid programs mandated by the Patient Protection and Affordable Care Act (PPACA). In the interim final rule, CMS exercised its discretion in expanding the requirements of the legislation in ways significant to imaging centers and radiology practices across the country. Notably, the rule places new burdens on providers to maintain written orders for imaging services and to indicate the legal name and national provider identifier (NPI) of the ordering physician or practitioner on the claim.

The interim final rule represents one of the first efforts by CMS to issue rules implementing the requirements of the PPACA. In this effort, CMS addressed three separate issues. First, the new rule requires both the furnishing and ordering provider or supplier of Medicare Part B services to maintain documentation of the (apparently written) order or referral for seven years. Second, it requires providers and suppliers to include their NPIs on all Medicare enrollment applications, as well as on all claims submitted to the Medicare and Medicaid programs. Third, the rule requires physicians and other eligible professionals who order services for Medicare beneficiaries to be enrolled in the Medicare program or to maintain a valid opt-out record.

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Scenario Planning for Health-care Organizations
By Elaine Sanchez

If you’re not scenario planning, you’re not planning. This bold assertion, issued in a recent white paper by GE Healthcare, is the driving philosophy behind the company’s $6 billion healthymagination initiative, and is an approach that it hopes to spread among health-care organizations. Survival in the health-care industry demands scenario-based planning, Tim Butler, senior consulting manager at GE Healthcare Performance Solutions, Waukesha, Wis, explains.

Through his consulting role with Performance Solutions, Butler assists health-care organizations with scenario planning based on GE’s own model, which entails setting goals based on assumptions on how the industry will evolve. To understand their current positions in the marketplace, organizations must begin by periodically asking certain questions of themselves: Who are we? What is our role? What are we trying to become?

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Effective Quality Assurance: Obstacles and Pointers
By Cat Vasko

As the radiology marketplace matures, becoming increasingly competitive, it’s more important than ever for practices to differentiate themselves based on quality, according to Peter Franklin, MD, chair of radiology for Radisphere National Radiology Group, Cleveland, Ohio. “The bar has been significantly raised,” Franklin observes. “The referring physicians know there’s the potential for excellence out there, and they’re not only demanding it—they want proof that the radiology services they’re ordering are of the highest possible quality.”

Franklin sees two primary forces at work in the marketplace that have created this demand for consistent, proven quality in radiology. The first is the proliferation of imaging in medicine, which he sees as a double-edged sword: as the specialty spreads, nonradiologist clinicians are both more reliant on and more familiar with good imaging.

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Employing a Differentiation Strategy
By Rich Smith

Attracting referrals is more crucial than ever for imaging-center operators who hope to see their facilities survive, and even thrive, in these difficult times. The task of maintaining or increasing market share, however, is complicated by aggressive competitors, each of which wants to be recognized by the greatest possible number of physicians and patients as the go-to place for diagnostic work-ups.

It is precisely so in Atlanta, Georgia, where Outpatient Imaging & Specialty Care at Camp Creek (OISCC)—an affiliate of the 338-bed South Fulton Medical Center in East Point—has made referral growth a priority. Freestanding OISCC distinguishes itself in its market by offering the patient community high-quality MRI services on a patient-friendly, high-field open system. Although several OISCC competitors also offer open MRI services, OISCC’s system is 1.2T—nearly double the field strength of the nearest rival’s open-bore machine.

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Have RIS/PACS, Will Travel
By Cat Vasko

For over thirty years, Radiation Physics Inc (Beltsville, Maryland) has been providing mobile imaging services to the Baltimore and Washington, DC, metropolitan areas, serving long-term–care and assisted-living clients, as well as prisons and private residences. “We started doing this in 1976, and the business model has been pretty much the same ever since,” Lou Rubin, president of Radiation Physics, explains. “The technology is really the only thing that’s changed.”

The first technological transition that Radiation Physics underwent was moving from analog to digital radiography, which the company did with the purchase and installation of CR technology from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut. “We have two vans with CR processing units in them, and 20 radiography machines out on the road that use digital cassettes instead of film cassettes,” Rubin says. “The technicians can either come into the office or meet one of the CR vans to process the cassettes. From there, wireless routers on the vans transmit the studies back to the office to be read by our radiologists.”

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A Step-by-step Guide to Implementing PQRI
By JoAnn Baker, CCS, CPC-H, CPC, CHCC, CAC

The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system. The requirement called for an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries. CMS ultimately named this program the Physician Quality Reporting Initiative (PQRI). The program is now a centerpiece for organizations trying to improve clinical care and capture appropriate revenue.

Make PQRI work for your organization by following a checklist of six steps.

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Business 101: Goal Setting and Strategic Planning
By Cat Vasko

This article is the second installment in a four-part series on applying basic business concepts to radiology. To read the first installment, click here.

Goal setting and strategic planning are important processes for any business, and though radiology practices are no exception, many of the challenges they face are unique to the imaging industry, according to Greg Thomson and Dan Simile Jr of Medical Management Professionals, Inc. (MMP), Atlanta, Georgia. “The whole business model of radiology starts with volume, and you begin looking at volume by asking, ‘Who is my customer?’” Simile says. “That is the most critical aspect a radiology group should consider: you are either in the business to make a living or because you love medicine, but either way, it has to support you economically, and for that, you need volume.”

During the past few years, Thomson observes, radiology’s customer base has evolved: Though patients, referring physicians, and hospitals have always composed the customer mix, “It used to be that referring physicians were at (or near) the top of the customer list, and now hospitals have taken that position,” he says. “Hospitals are replacing radiology groups, so the importance of keeping that customer happy has grown dramatically. Defining your customer upfront (and realizing where hospitals, in particular, are on that list) is important.”

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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

CMS Finalizes MRA Coverage Determination
CMS has officially removed its national noncoverage determination on MR angiography (MRA), enabling local Medicare contractors to make their own coverage decisions on all indications for MRA that are not specified by the agency as nationally covered or noncovered. CMS decided that separate national coverage determinations for MRA were unnecessary because the technique is a specific application of MRI.

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SGR Fix Approved by House
On May 28, the House of Representatives voted (245 to 171) to replace the 21.2% Medicare physician-payment cut mandated by the sustainable growth rate (SGR) formula with 19 months of positive updates: a 2.2% update for the balance of 2010 and a 1% updated in 2011. The payment cuts were set to kick in on June 1, but CMS said that it would hold claims for at least 10 days while the SGR fix goes to the Senate for a vote.

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Benchmarks for Radiologist Productivity
An article in the most recent issue of Journal of the American College of Radiology: JACR, the first in a two-part series on measuring and managing radiologist productivity, details metrics and reviews published benchmarks for evaluating radiologist productivity. The article also explores the issues and limitations that might prevent successful implementation of measurement systems, concluding that "meticulous attention to identifying appropriate metrics . . . and then appropriately applying them" are the first steps in tackling productivity disparities.

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Tuomey to Pay $44.9 Million in Claims
Following a March trial during which a jury concluded that a number of the company's arrangements with physicians violated the Stark self-referral law, Tuomey Healthcare System, Sumter, South Carolina, must repay $44.9 million derived from Medicare claims. The jury did not find that Tuomey Healthcare System had violated the False Claims Act, and it awarded nothing to the government, which had joined the whistle-blower lawsuit brought against the system by a surgeon in 2005.

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CTC Bill Introduced in House
On May 28, Reps Danny Davis (D-IL), Mark Kirk (R-IL), and Dan Boren (D-OK) introduced the Virtual Screening for Colorectal Cancer Act of 2010 into the House. It would require CMS to cover screening CT colonography (CTC) for Medicare beneficiaries. The ACR® is urging Congress to pass the bill, noting that many private payors (including CIGNA, UnitedHealthcare, and Anthem Blue Cross Blue Shield) cover screening and diagnostic CTC for their enrollees.

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JUNE

2010 ANI Healthcare Finance Conference
Sponsored by the Healthcare Financial Management Association

June 20–23
Sands Expo Center and Venetian/Palazzo Resort Las Vegas, Nevada

The HFMA's annual conference on health-care finance will focus on the current economic and health-care climate, with sessions on reform, quality and cost, physician integration, the revenue cycle, and more.

[Register]

AUGUST

AHRA 2010 Annual Meeting and Exposition
Sponsored by AHRA: The Association for Medical Imaging Management

August 22–26
Gaylord National Resort and Convention Center, Washington, DC

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.

[Register]

SEPTEMBER

2010 RBMA Fall Educational Conference
Sponsored by the RBMA

September 26–29
Renaissance Austin Hotel, Austin, Texas

This year's RBMA Fall Educational Conference will feature more focused education in track format, with tracks including billing, legal, human resources, imaging centers, interventional radiology, and technology.

[Register]