THE BIG PICTURE

The Industrial-strength Imaging Executive
By Curtis Kauffman-Pickelle

Today’s medical-imaging profession is definitely not for the fragile and weak-kneed among our colleagues. It is becoming increasingly clear that navigating the constant changes and challenges that face the practice of radiology today will be the ultimate test of tenacity, perseverance, and creativity. We’re in the playoffs now, and the game is moving to the big-time arena—where the margin for error is nil.

As in any aspect of world-class competition, the choices for those who intend to stay in the game for the long run will be dictated by their basic sets of skills, which will either prepare them for what’s to come or eliminate them in an early round. Washington’s legislators and regulators, regional payors, and state agencies all have imaging in their sights for targeted reimbursement cuts that will continue to drain the will of those unprepared to adjust to (and compensate for) lower per-exam revenue.

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Health Reform’s Impact on Imaging
By Ed Gaines and Missy Lovell

Plenty remains unknowable about the incipient impact of the Patient Protection and Affordable Care Act of 2010 (PPACA), but the act does stand to affect imaging providers, specifically through its compliance, fraud, and payment provisions, many of which have already taken effect or will take effect in the near future.

The statute gives an unprecedented level of authority to the secretary of HHS, relying on that office to define and narrow the scope of broad concepts. For instance, the bill states that the DHHS may impose a series of requirements for Medicare-reimbursed providers, ranging from criminal background checks to unannounced site visits.

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Sparking the Storage and Sharing Revolution: Symantec Health’s Lori Wright
By Cat Vasko

Radiology has a storage problem, to put it lightly: Even as the data associated with a single cross-sectional imaging study increase dramatically, HIPAA requirements to ensure patient privacy remain as stringent as ever. At last year’s RSNA meeting, a new solution appeared on the horizon in the form of cloud storage—a concept that has gained traction in other industries, but has been slower to penetrate the health-care space. ImagingBiz spoke with Lori Wright, vice president and general manager of Symantec Health, Mountain View, California, a company more closely associated with data security than with health care, on why the time is right for radiology to take to the clouds.

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Beyond the Basics: Next-generation Radiology Reports
By George Wiley

At Shields Health Care Group (SHCG), an outpatient high-end imaging provider headquartered in Quincy, Massachusetts, staying ahead of the technology curve has been a clearly defined business initiative from the beginning. It is paying off handsomely. According to the company, one in every three MRI patients in the state is imaged at an SHCG center.

SHCG has leveraged the capabilities of its RIS to create customized radiology reports that are popular with referrers. “One of the biggest things we’re doing is something we call e-protocols,” Patricia Whelan, MHA, vice president of IT at SHCG, explains. “In our RIS, this allows the physician who views the images for the referrer to select the protocols used to view images. This feature is really important for a RIS because it allows you to tailor the exam specifically to what it is that your referrer would like.”

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Succession Planning for Health-care Organizations
By Cat Vasko

According to a 2004 study by the American College of Healthcare Executives, only 21% of 722 hospitals routinely engaged in leadership-succession planning, compared with two out of three for-profit companies in other industries. Will Powley, senior consulting manager for GE Healthcare’s Performance Solutions group, Waukesha, Wisconsin, says that this is no surprise. “In my experience, health-care systems can become very short sighted and reactionary because a hospital is a place where people come to get treated, so they put most of their resources into quality and patient care,” he observes. “By the nature of their business, they’re always in the moment, and they have a tough time stepping back and doing more strategic thinking.”

What can health care learn from the succession-planning practices of businesses in other industries—and why is succession planning so critical? Powley points out that the accretive financial impact of leaving a top position unfilled for any length of time can be staggering, and with a generation of baby boomers set to retire in the coming years, health care literally can no longer afford to neglect the process of shaping its next generation of leadership.

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Health Care’s New Financial Outlook
By Kris Kyes

A window of access to capital has opened for hospitals, according to Lisa Goldstein, because of the improvement in the debt markets seen over the past six to nine months. On June 23, 2010, at the Healthcare Financial Management Association’s ANI: The Healthcare Finance Conference in Las Vegas, Nevada, Goldstein presented “Navigating the 2010 Capital Market: A Rating Agency Perspective.” She is senior vice president of health-care ratings at Moody’s Investors Service, New York, New York.

In health-care finance, Goldstein says, access to capital has been a primary concern, and uncertainty has made agency ratings more important than ever. Cutting expenses to the bone in 2009 produced much of the improvement seen now in hospitals’ financial standing, but unpredictability reigns in health care in 2010, so the capital-access window might not remain open for long, and the pent-up demand for capital is considerable. Investment in IT, Goldstein adds, should be a priority for many hospitals because it will support efforts to improve throughput, enhance quality, and reduce expenses.

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New Radiology-department Solution Opens New Doors
By Cat Vasko

Integration has been a buzzword in the radiology community for some time, and the team at Valhalla, New York-based Westchester Medical Center (WMC) knows why. “We used to have PACS, RIS, and voice recognition all working separately from one another,” Mike Seiler, director of radiology IT at WMC, explains. “Today, they’re all tightly integrated. We had disparate systems, and now we have one.”

WMC implemented its first IT tool for radiology, a RIS, in the dark ages of health IT: 1996. Originally manufactured by a small, Texas-based company that subsequently went out of business, the platform was acquired by a second vendor in 2002; that vendor eventually determined that the product would sunset in late 2009. Zvi Lefkovitz, MD, director of the department of radiology at WMC, says, “The system was archaic. It really stopped being useful in 2002, and since it was set to sunset last year, we were in a good position to go shopping for a more integrated system.”

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The SGR Fix Passes With a 2.2% Update
By Jane Cys

The familiar, contentious debate surrounding Medicare’s sustainable growth rate (SGR) formula came to a temporary close on June 24, when the House of Representatives, by passing HR 3962, finally agreed to a Senate plan to put off a 21.3% decrease in payment rates. The payment fix is only effective through November 30, however, ensuring yet another go-round of Congressional debate on the SGR this fall.

The legislation, which President Obama signed into law on June 25, retroactively reverses the scheduled 21.3% payment cut and approves a 2.2% increase in physician payments.

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The Economic Case for Patient-friendly Imaging
By Cat Vasko

As the technology used for radiologic studies matures, providers and referrers are increasingly focused on providing patients with a friendlier imaging environment—with good reason, according to Tariq Gill, MD. “We need to make a conscious effort to make things nonthreatening,” he says. “In our community, we have three main hospitals, and each one has its own style that patients can sense. Providing a patient-friendly environment isn’t just a care-giving issue—it’s a business issue.”

Gill is chair of the diagnostic-imaging department at 365-bed Our Lady of Lourdes Memorial Hospital (OLLMH), Binghamton, New York, which is currently undergoing a $70 million renovation in its radiology and emergency departments for this very reason. “Every time somebody walks into a hospital, it’s a very threatening environment,” he says. “A little bit of cosmetics and the right technology can go a long way.”

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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
Jane Cys

ACR Revises Appropriateness Criteria
The ACR® has revised and added to its ACR Appropriateness Criteria. Changes to the criteria include five new topics—treatment of uterine leiomyoma, treatment of lower-extremity venous insufficiency, cranial neuropathy, local–regional therapy for resectable oropharyngeal squamous cell carcinoma, and retreatment of recurrent head and neck cancer after prior definitive radiation—as well as revised relative radiation-level categories for diagnostic-imaging exams.

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CMS Expands Hospital Compare Site
CMS has expanded its Hospital Compare website to incorporate new outpatient-care data. New information available on the site includes two measures related to antibiotic administration in outpatient-surgery patients, four measures related to outpatient care during potential heart attacks, and four measures related to the use or overuse of medical imaging.

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Paper Reports on Radiology for Developing Countries
A report in the most recent issue of Journal of the American College of Radiology: JACR recounts the findings of the RAD–AID Conference of International Radiology for Developing Countries. Four main factors were identified by the group as important to the implementation of radiology in the developing world: ensuring the economic sustainability of radiologic services; designing, testing, and deploying clinical strategies for regions with limited resources; structuring and improving the role of US radiology residents' interest in global health service; and implementing IT models to support digital imaging in the developing world.

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Options Lacking in HIE Market: KLAS Report
According to a new KLAS report, while health information exchange (HIE) vendors are popping up left and right, the current HIE market lacks serious options. Many vendors have only a handful of implementations under their belts, undermining providers' confidence in their services. The report examines the HIE purchase plans of nearly 100 health care organizations and finds that only five companies (of 38) were considered in more than 10% of buying decisions.

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Daily ICU Chest Radiographs Are Unnecessary
According to a recent Radiology study that analyzed eight clinical trials over a 12-year period, daily routine chest radiography in the ICU has no impact on a patients’ mortality or lengths of stay. Study coauthor Yuji Oba tells RSNA News that the practice is unlikely to decline anytime soon, however, saying that research from the 1980s and 1990s might have exaggerated the usefulness of the daily radiographs, compounding reliance on them. Oba recommends that ICUs, instead, should perform chest radiography when it is clinically indicated (to reduce workloads, radiation exposure, and overall costs).

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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.

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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.

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Economics of Diagnostic Imaging 2010
Sponsored by ESI Educational Symposia

October 27–31
Gaylord National Resort and Convention Center Washington, DC

This 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]