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The Big Picture
Imaging’s Generational Divide
By Cat Vasko
I have asked ImagingBiz.com’s editor, Cat Vasko, to join me in writing these commentaries, and to provide some perspective on those topics that I feel she is uniquely suited to address. This is the first thought-provoking piece from her in this capacity, but it will certainly not be the last.—CKP 
I first heard the topic of generational differences as they pertain to radiology management raised at the 2009 RBMA Fall Educational Conference in Chandler, Arizona, where speaker Dave Jakielo, former president of the Healthcare Billing and Management Association, elicited both sympathetic groans and laughter of recognition as he cited some of my generation’s worst traits. As a certified member of generation Y, I learned that I’m part of a group that is generally considered lazy and entitled, yet in need of constant positive reinforcement. I wanted to stand up and defend my generation, but what would have been more entitled or reinforcement seeking than that?
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The e-PHI Conundrum: What Constitutes a Breach?
By Rich Smith
 Tucked within the American Reinvestment and Recovery Act (ARRA) of 2009 (intended to jump-start the stalled US economy with an infusion of nearly $1 trillion) was a provision to provide $25.8 billion for modernization of the nation’s health-care information highways and the electronic patient health records traversing them. Toward that end, the US DHHS was authorized to write a number of rules governing how such records were henceforth to be handled by those individuals and organizations creating, storing, and/or disseminating them.
It is now 30 months later, and the DHHS has yet to complete the task—but of the few regulations thus far implemented, the one that seems most responsible for generating complaints of confusion is that pertaining to security-breach notifications.
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Digital Solutions Without Compromise: A Conversation With iCRco CEO Stephen Neushul
By Cat Vasko
 iCRco is an established imaging manufacturer and software developer that provides complete digital-imaging solutions. In business for nearly 20 years, the company houses research and development, software engineering, and technical support—as well as sales and marketing teams—under one roof at its headquarters in Torrance, California.
iCRco has developed a range of low-dose CR and DR imaging products, in addition to PACS software; together, they constitute complete imaging solutions for a variety of settings, including hospitals, imaging centers, and military installations. ImagingBiz.com spoke with CEO Stephen Neushul about the company’s solutions and his vision for the future of CR and DR.
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Mind the Gap: Benefits Planning for Multiple Generations
By David Myrice, CPA, MBA
 Radiology practices trying to recruit the most promising young talent—particularly those facing the retirement of multiple baby-boom–generation radiologists—will inevitably face decisions related to benefits planning. The most contentious of these might be the practice’s retirement-plan offering, as the recent vagaries of the stock market have exposed both the risks and benefits associated with the two most common types of retirement plans.
Defined-contribution plans, generally speaking, have more to offer younger members of the practice, while defined-benefit plans might have more to offer those closer to retirement. A combination of the two has been a common approach for medical practices, but it might be worth a review of each plan’s age-related issues as recruitment increasingly becomes a priority—and as returns on investment (ROI) become less predictable.
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Interventional Radiologists Looped Into Self-referral Battle
By Cat Vasko
 It was a small change with a big impact: On October 1, 2009, a provision of the 2009 Hospital Inpatient Prospective Payment System final rule amended how an entity is defined under the Stark self-referral law. Until then, a Stark entity had been defined as the person or organization that billed for a given service; the change expanded the definition to include the person or organization that performed the service as well.
Tom Greeson, JD, partner with Reed Smith LLP, Falls Church, Virginia, says, “They were basically filling a loophole. The change made it so that entity includes not only the entity that bills for the service, but also an entity, like a joint venture, that performs the service and then sells it to someone else.”
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Radiologists Seek Prestige, Lifestyle Benefits
By Rich Smith
 The number-one reason cited by its radiologists for choosing a non-traditional practice setting is to align with a leading organization, according to a survey of its physicians by Radisphere, Westport, Connecticut. Running a close second and third were lifestyle/schedule flexibility and the backing of a professional support team, the poll reveals.
The ultimate indicator of practice satisfaction is the number of radiologists who would recommend the practice to others: 92% of the radiologists surveyed say that they would refer a colleague to work for Radisphere, a hybrid practice model based on remote reading and on-site radiologists.
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Optimizing Patient Satisfaction for Higher Reimbursement
By Cat Vasko
One of health-care reform’s least controversial mandates was a requirement that hospitals improve their patient-satisfaction scores or take a reimbursement hit. In October 2012, CMS is set to begin withholding 1% of its payments to hospitals, putting the money (estimated at around $850 million for the first year) into a bonus pool that will be divided among hospitals that score highly on an array of measures, including “physicians always communicated well,” “got help as soon as they wanted,” and more. As Corinne Kereszturi, director of improvement services for Press Ganey Associates Inc, South Bend, Indiana, notes, “A lot of times, the challenge is making process changes that patients may feel, but won’t see.”
The CAHPS® hospital survey is the tool that CMS uses to collect feedback on the patient experience, with questions posed to patients in several topic areas: clinician communication, pain control, explanation of medicines, cleanliness of rooms, noisiness of rooms, and recovery information. The survey also asks patients to rate the hospital on a scale of 0 to 10 and to say whether they would recommend it to friends and family members.
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Colleague Feedback Influences Physician Test Ordering
A reduction in the number of unnecessary ordered tests can result when physicians receive feedback from fellow doctors, according to a study published in the Journal of Urology. The study involved an investigation of diagnostic practices by physicians treating 858 patients with early-, middle, or late-stage prostate cancer. At the beginning of the study, many doctors initially ordered CT or bone scans to determine whether their patients’ cancer had metastasized to other parts of the body. However, input from colleagues and training in professional guidelines that cover when such tests are warranted led the participating physicians to change course. At the conclusion of the 16-month study, they were ordering CT scans on a mere 16% of low- or medium-risk patients and bone scans for only 13% of that same patient population.
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EHR Usage on the Rise
Electronic health record (EHR) adoption in physicians’ offices across the U.S. is on a slow, but steady uptick, according to survey results released last month by health care marketing solutions firm SK&UA. The study shows that an increasing number of mid-sized and large practices are jumping on the EHR software implementation bandwagon. Overall, deployment of software in this category is up by nearly 2% since October 2010, with 40.4% of respondents, up from 38.7% of respondents, indicating that they now utilize EHR technology.
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Study Links Increased CT Scan Usage, Lower Hospital Admission Rates
A new study shows a correlation between volume of CT scans administered to hospital admission rates, with the latter falling as the former increase. According to the study, which was published online in the August 9 issue of Annals of Emergency Medicine, the use of CT scans in emergency departments increased by 330% between 1996 and 2007, from 3.2% of patient visits to 13.9% of patient visits. But just as CT scan usage rates in emergency rooms rose during the time period studied, the rate of hospitalization fell. In 1996, the rate of hospitalization following CT scan was 26%. However, over the five-year time span, this figure dropped by more than 50%, to just 12.1% at the conclusion of the study in 2007.
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SEPTEMBER
Webinar: Developing a Comprehensive IT Strategy for the Practice
Sponsored by 
Save the date: September 13
Mark Alfonso, MD, president, Riverside Radiology
Marcia Flaherty, CEO, Riverside Radiology
Ron Hosenfeld, CIO, Riverside Radiology
Jim Morgan, Vice President, Medical Informatics, FUJIFILM Medical Systems USA, Inc
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OCTOBER
2011 RBMA Fall Educational Conference
Sponsored by the RBMA
October 16–19
Aria Resort and Casino
Las Vegas, Nevada
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2011 Community Hospital Executive Management Conference
Sponsored by Community Hospital 100
October 23–25
Pinehurst Resort
Pinehurst, North Carolina
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Economics of Diagnostic Imaging 2011
Sponsored by ESI Educational Symposia
October 27–30
The Ritz-Carlton Pentagon City
Arlington, Virginia
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