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THE BIG PICTURE
It’s All About Scale
By Curtis Kauffman-Pickelle
 An October 26 commentary in the Wall Street Journal entitled “Big Insurance, Big Medicine” was prescient in its evaluation of the impact on the health-care profession—the business of medicine—of the Patient Protection and Affordable Care Act. I say prescient because the predicted impact happens to parallel the transformation of the business side of medicine in ways that I have discussed in this column for the past few years; for example, consolidation has been an economic reality in the imaging segment, but is now likely to be catalyzed by the new health-care structure.
As the article notes, “Size is important in low-margin businesses . . . scale is far more central now [to insurance companies] . . . they will essentially be selling commodities, and survival will depend on enrollment volume and market share.” The article goes on to state that nearly a third of US hospitals are currently operating in the red, and many of them will be consolidated into national chains and larger local systems; likewise for physician practices. Special mention was made of recent data from the American College of Cardiology indicating that nearly 40% of private cardiology groups are currently integrating with hospitals or merging with other practices.
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Mammography’s Crisis Offers Opportunity, Too
By George Wiley
 Michael N. Linver, MD, FACR, is committed to mammography screening to detect breast cancer—what he calls screening’s role in saving women’s lives. When it comes to mammography, Linver also has a combative side: Now that screening mammography has come under attack from some critics as a possibly less-than-effective technique, Linver is fighting back. He has cited study after study showing that the death rate from breast cancer has dramatically fallen because of mammography screening.
“If every woman in the United States had a mammogram now, we would find 500,000 breast cancers, and save 15,000 lives, this year alone,” Linver told the audience at a breast-imaging event held in White Plains, New York, on October 5, 2010, and hosted by Sectra AB, a global RIS/PACS solution provider with US headquarters in Shelton, Connecticut.
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Physician-recruiting Strategies for Radiology
By David Anderson, CPA
 In spite of downturns in volumes and concerns about further reimbursement cuts, radiology physician recruiting remains a seller’s market, at least for the time being. More groups are looking for radiologists than there are qualified candidates, putting pressure on practices to optimize their recruiting techniques. While the recent changes in the health care industry might eventually lead to a reversal of this situation, for the time being, economic uncertainty is actually heightening the importance of effective physician recruiting.
What does your practice have to offer potential recruits—and what are those recruits looking for in a practice? What are other practices putting on the table, and how can you stay competitive? In many cases, the answers to these questions align neatly with strategic best practices. Recruits are hoping to join a group that will be able to survive the turmoil to come, and even the seemingly ancillary benefits they expect mirror industry trends toward improved efficiency and productivity.
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Riverside Radiology Doubles Down on Distributed Reading
By Cat Vasko
 
To improve patient care and further build its business, Riverside Radiology of Columbus, Ohio, wanted to provide 24/7, subspecialized service to all 10 of its hospital clients. The busy radiology practice, with 70 physicians, was already providing 24/7 coverage to its hospitals, but according to Mark Alfonso, MD, president of Riverside Radiology, “We wanted to be able to offer the same level and quality of service across our entire enterprise. We didn’t want any areas not to be getting the same attention as others.”
The answer was implementing a distributed reading solution that would enable Riverside Radiology’s physicians to read from a single worklist, irrespective of where the studies originated. The practice was using the Synapse® PACS from FUJIFILM Medical Systems USA, Inc, Stamford, Connecticut, and its radiologists decided that they wanted to continue to read through the Synapse CommonView interface.
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Imaging-center Data: Interpreting New Industry Volume Trends
By C. Elliott Jeter, CFA, CPA/ABV, and Colin McDermot
  Analysis of the fair market value of an imaging center requires the analysis of disparate sets of information regarding the environment in which the subject company operates. The valuation analyst will research various sources of economic and industry data, as well as obtaining company-specific information as part of the analysis.
Radiology Business Journal
and SDI Health LLC (Plymouth Meeting, Pennsylvania) published an article in the August/September issue of RBJ illustrating trends related to the top 20 imaging-center chains and the larger environment in which they operate. The data in this study can assist the valuation analyst in formulating a basis for future revenue projections used in the income approach (discounted cash flow) to analysis.
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Improving Quality While Boosting Revenue: CMCH Case Study
By Jane Cys
When Bill Lawrence became CEO of Central Michigan Community Hospital (CMCH) in Mt Pleasant, in 2008, he began examining options for improving the hospital’s radiology services. Declining volumes, long turnaround times, and lack of specialization were among the issues that had led to increasing dissatisfaction with the hospital’s radiology services. 
After reviewing several options, Lawrence chose to outsource the radiology professional services of this 118-bed community hospital to Radisphere National Radiology Group, Beachwood, Ohio, which serves hospitals in more than 30 states; CMCH kept only a radiology practitioner assistant (RPA) on staff. Lawrence shared CMCH’s experience in transitioning to outsourced radiology in a presentation entitled “Core No More” at the Community Hospital 100 meeting in Williamsburg, Virginia, held October 4–5, 2010.
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The ACR GRID Program: Ready for Its Close-up
By Cat Vasko
A relative newcomer amongst the ACR® data registries is the General Radiology Improvement Database (GRID) program. Part of the ACR’s National Radiology Data Registry, GRID’s focus is evidence-based health outcomes and process data; the program was launched as a pilot in 2008 and began official operation in 2009. Today, the GRID program has 23 active facilities contributing information in accordance with two levels of membership: green (reporting primarily on process measures) and gold (reporting on both process measures and outcomes). 
Mythreyi Bhargavan Chatfield, PhD, director of data registries for the ACR, says, “We’re still in the process of growing. We offer two levels of participation because we understand that outcome measures can be more difficult to track and report, and we didn’t want facilities not participating because they were unable to get outcome data.”
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California Dose Legislation: National Implications
By Jane Cys
Arnold Schwarzenegger, California’s governor, signed a new radiation patient protection law in October 2010 that mandates strict procedures and reporting requirements for CT scanners and radiation-therapy procedures, as well as the reporting of radiation overdoses to the state’s Department of Public Health (DPH). Whether the law prompts similar measures in other states (or at the federal level) remains to be seen. Robert Achermann, executive director of the California Radiological Society (CRS), says, “I’ve had calls from other states where the issue is being raised. Even though the incidents that drove this issue were from California, it is an issue of nationwide interest.”
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Member of the following organizations:
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INFORMATION RESOURCES
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Results: Breast MRI in Community Practice
An article in the November issue of Journal of the American College of Radiology: JACR surveys the methods of 14 Breast Cancer Surveillance Consortium facilities performing breast MRI. Facilities reported on 18 imaging parameters; compliance with field-strength recommendations was 94%, and 100% of facilities used a dedicated breast coil. Of the facilities surveyed, 63% met the requirement for exam completion within four minutes. “Further guidelines by the ACR Breast MRI Accreditation Program will be of importance in facilitating standardized and high-quality breast MRI,” the article concludes.
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Health Care Added 24,100 Jobs in October
According to data from the US Bureau of Labor Statistics, health-care employers added 24,100 jobs in October 2010, continuing a winning streak in which the industry has added more than 23,000 jobs each month since July. Hospitals added 5,100 jobs, while physicians’ offices added 2,700 jobs. Physicians’ offices have grown twice as quickly as hospitals in the past year, adding 1.8% to a workforce of 2.3 million; hospitals have added 0.8% to a workforce of 4.7 million.
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NLST Halted Due to Positive Results
The National Lung Screening Trial was halted in the first week of November in light of extremely positive results. Eight-year results indicate that screening heavy smokers using low-dose helical CT significantly reduced deaths from lung cancer, compared with screening the same population using chest radiography. In a statement, the ACR® says that the results “speak volumes to the ability of helical CT screening of high-risk patients to save lives,” and notes that a cost-effectiveness study that would aid Congress in developing a Medicare-subsidized screening program is likely to be on its way. The statement also notes that private insurers will probably conduct their own studies of the cost-effectiveness of lung-cancer screening on a large scale.
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Radiology Salaries Flatlined in 2009: Survey
The November issue of RSNA News shares the results of the 2010 American Medical Group Association’s 22nd Annual Medical Group Compensation and Financial Survey. According to the survey’s results, radiology salaries either remained level or kept pace with inflation in 2009; diagnostic radiologists reported a median salary of $454,205, while interventionial radiologists’ median salary was $478,000. Brad Vaudrey, MBA, CPA, a director with the RSM McGladrey Health Care Practice consulting group (which administered the survey) notes that these numbers are expected to rebound this year, but says, “the days of double-digit increases are behind us at this point.”
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COMING EVENTS
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NOVEMBER
RSNA 2010
Sponsored by the RSNA
November 28–December 3
McCormick Place Convention Center Chicago, Illinois
With 4,200 scientific papers, posters, and educational exhibits; over 700 technical exhibitors; 300 refresher courses; and new special-interest and hot-topic sessions, the largest conference of medical imaging professionals in the word will offer relevant, cutting-edge science, education, and technology.
[Register]
RSNA 2010 Leadership Forum
Sponsored by Medical Management Professionals
November 29, 6:30–8:00 am
Hyatt Regency McCormick Place Chicago, Illinois
Featuring imagingBiz CEO Curtis Kauffman-Pickelle and Greg Thomson, executive vice president of Medical Management Professionals, this year’s leadership forum focuses on the topic of “Business Execution During a Tumultuous Radiology Environment.”
[RSVP]
DECEMBER
National Diagnostic Imaging Symposium 2010
Sponsored by World Class CME
December 5–9
Disney Contemporary Resort, Lake Buena Vista, Florida
Featuring 40 faculty members delivering 120 lectures in concurrent sessions, the symposium will focus on radiology subspecialties including musculoskeletal imaging, 3D and cardiovascular imaging, chest radiology, body CT and MRI, emergency radiology, PET and PET/CT, neuroradiology, ultrasound, and breast imaging.
[Register]
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