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The Big Picture
Monopoly Money
By Curtis Kauffman-Pickelle
 You know how good it feels. You finally did the right trade and now own Boardwalk and Park Place. Everyone who has the misfortune of landing on your block of expensive property pays through the roof, and you smile all the way to the bank. It is great fun owning a monopoly—unless, of course, you have those pesky regulators at your back, asking difficult questions about escalating rates and poor service.
Converging issues in medical imaging bring to mind thoughts of the consequences of monopoly in health care. In the August 27 issue of the Wall Street Journal, Mathews¹ chronicles the result of some of the deals currently in vogue in outpatient imaging. We have all experienced that little smile when we hear of a hospital acquiring majority control of an outpatient imaging practice, with the immediate upside of increasing reimbursement simply because of the change in ownership and the ability to bill at the hospital rate. Same physicians, significantly increased price: When you own Broadway and Park Place, you can do what you want.
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Cloud-based RIS/PACS Reaches the Mainstream
By Cat Vasko
 Cloud-based technologies have been relatively slow to penetrate the health-care IT market, but several advances in technology—as well as federal programs that encourage the adoption of interoperable solutions—are changing that, according to Vijay Ramanathan, CEO and cofounder of RamSoft Inc. “The biggest trend that is driving cloud computing, in our industry, is what is happening overall in the consumer world, where individuals are using more and more cloud-based services,” he notes. “Every iPhone or iPad is backed up in the cloud. That is going to reduce the perceived risks involved with cloud computing.”
As software has become more sophisticated in the consumer industry, it has also progressed in other industries, Ramanathan says. “The software design is a significant factor, and today, it’s becoming more intelligent,” he says. “Images are not the same as text information, so the architecture has evolved: A PACS solution doesn’t have the same design as an online-banking website.”
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Proposed CMS Changes to the Cost-of-capital Assumption: Analysis
By Todd Sorensen, AVA
 For 2012, CMS proposed a reduction in the cost-of-capital (or interest-rate) assumption used in the development of the cost-of-equipment estimates that are included in the practice-expense component of the RVU calculations. Historically, CMS has used an interest-rate assumption of 11%. Based on the current prime rate and maximum interest rates for Small Business Administration (SBA) loans, the proposed changes would result in a drastic reduction of these rates to 6% (or less) for most types of major medical equipment.
On the surface, it might appear that the cost of borrowing has declined over the past several years, but this concept is inconsistent with our experience in completing valuations for hundreds of health-care facilities and services since our inception in 1995. Further, the data for publicly traded health-care companies do not support a cost-of-capital assumption of 6% or less.
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Optimizing the Vendor-neutral Archive for Enterprise Use: UVA Health System
By Greg Thompson
 No health-care enterprise wants to make an enormous investment in technology for image storage, only to find it outdated and in need of an upgrade. The vendor-neutral archive has been proposed as a natural antidote to this problem, but an archive alone is, increasingly, not enough—particularly for large academic institutions that intend to improve workflow and access dramatically. The UVA Health System (Charlottesville, Virginia) was facing just such an issue: It needed to boost efficiency and consolidate storage for imaging across the enterprise, and it wanted to move and monitor images across its multiserver network.
Because a high volume of incoming studies caused multiple problems, Daniel O’Malley, UVA Health System’s director of informatics and support services, specifically went looking for better routing capabilities. “We had PACS tools that were able to move images based on certain DICOM tags,” he says. “We had outgrown them, however, particularly with our added teleradiology capabilities and our new cloud-based image-transfer mechanisms.”
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Patient-centered Care, Technology, and the Imaging Center: ProScan Imaging
By Cat Vasko
  In September, ProScan Imaging, which owns a network of 25 imaging centers in seven states, became the first organization in the world to install the high-field Echelon Oval 1.5T MRI system from Hitachi Medical Systems. Featuring an oval-shaped bore that measures 74 cm, the Echelon Oval reflects the growing trend toward patient centricity in imaging technology design; it was the scanner’s patient friendliness that attracted ProScan’s
attention, says founder Stephen Pomeranz, MD.
“For years, MRI scanners came in open and closed varieties—the closed MRIs were more powerful, and the open scanners offered more comfort for the patient,” Pomeranz says. “We’ve seen well over a million MRs, and many times the patient will prefer the comfort and space of an open system, while his or her referrer will prefer the higher power of a closed.”
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Patient Portals Unlock New Service Levels for Radiology
By Cat Vasko
This article is the third in a four-part series. To read part one, click here; to read part two, click here.
 As radiology practices deepen their investments in IT, a key stakeholder to consider is the patient, according to Anthony Brown, director of IT for Medical Management Professionals (MMP). “Nationwide, there is a movement to get people engaged in their health care,” he notes. “Outcomes significantly improve when the patient is engaged in his or her whole care continuum. Taking that a step further, however, the question becomes how best to engage the patient efficiently.”
As Brown’s comment highlights, already-beleaguered radiology practices are not likely to have an easy or efficient means of connecting better with patients. This is why, increasingly, practices are using Web-based patient portals. “In today’s health-care environment, which is increasingly consumer driven, patients are already online looking for information,” he says. “A portal can help facilitate communication between patients and radiology practices in a way that is convenient for both.”
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Radiology and Social Media: A Tale of Two Practices
By Maril Hazlett, PhD
This article is third in a three-part series. To read the first article in the series, click here; to read the second, click here.
  Developing a social-media presence helps radiology practices develop their brands and build relationships with patients, referring physicians, and hospitals. Several practices have already tested these waters. Inland Imaging (Spokane, Washington) and Charlotte Radiology in North Carolina have successfully learned how to fit social media into their marketing strategies, create compelling content, and evaluate social-media return on investment (ROI).
Providing services throughout the Western United States, Inland Imaging became involved in social media as early as 2009. Pam Pyrc, director of marketing at Inland Imaging, recommends that radiology practices be very clear about their social-media goals. Her own goals include increasing brand recognition and inviting patient interaction and engagement.
Inland Imaging currently maintains an extensive social-media presence on Facebook, Twitter, LinkedIn, and Google+, as well as a few geolocation services. Inland Imaging also carries out extensive reputation monitoring on review sites (such as Yelp). Inland Imaging’s social-media team is made up of Pyrc and Adam Clear, digital marketing strategist .
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Patient Satisfaction With Imaging Is Increasingly Critical to Referrers
By Greg Thompson
 As health care becomes increasingly consumer driven, patients are expecting higher levels of service and satisfaction from their providers, including providers of medical imaging. Elliot Silverman, director of imaging services at Palmetto General Hospital (Hialeah, Florida), notes that many patients have only a vague notion of what’s in store when they go in for an imaging study. Positive or neutral experiences are quickly forgotten, but negative experiences can be remembered for a long time; referring physicians hear about them (and, no doubt, strive to avoid a negative patient experience in the future).
Dissatisfaction with the traditional closed MRI system is not uncommon, but when Silverman checked the competition near Palmetto General Hospital, he noticed a distinct lack of high-field, open MRI systems, despite the presence of 13 imaging centers within a five-mile radius. The comprehensive competitive analysis performed by Silverman and his colleagues resulted in the decision to add the Oasis 1.2T boreless MRI system from Hitachi Medical Systems America, Inc, to the hospital’s array of modalities.
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Lawmakers May Join Meaningful Use Conversation
Congressional Quarterly reports that at least one House committee may schedule hearings on the latest Meaningful Use requirements for electronic health record incentive payments after lawmakers return from their August recess. The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for HIT (ONC) published the final Stage 2 Meaningful Use rules in the September 3 Federal Register; the final rules had been available online since August 23. For radiology, the rules are a mix of benefits and challenges, and the American College of Radiology has been active in making sure the field’s concerns are heard by CMS and the ONC.
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ACR Issues Formal Response to Proposed MPFS
Reiterating its arguments from last year when the Centers for Medicare and Medicaid Services (CMS) first proposed a multiple procedure payment reduction (MPPR) on the professional component of imaging studies performed by physicians in the same group practice, the ACR pushed back hard against this idea in its formal written response to CMS. According to the ACR, there is little if any efficiency in two radiologists in the same practice reading images from a single patient taken in a single session because they are reading separate images, often of completely different portions of the patient’s anatomy. The ACR also argued that even if there were efficiencies, these would vary by procedure and setting and should be studied before an MPPR is set.
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ASTRO Responds to Proposed Reimbursement Cuts
Officials at the American Society for Radiation Oncology (ASTRO) hope a 16-page letter to CMS will help reverse a proposed 15% reduction in payment for radiation oncology services. CMS floated the decrease in late July as part of the 2013 Medicare Physician Fee Schedule (MPFS). With a final rule likely to be released in late October or early November, the stakes are high for both radiation oncology practices and the patients who use these services. CMS is looking to cut $300 million per year from the roughly $1.9 billion allocated for radiation oncology. Michael L. Steinberg, MD, FASTRO, president of the ASTRO Board of Directors, maintains that no other specialty is taking such a hit—a particularly galling development considering that even larger chunks of money are being doled out for less effective treatments.
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Breast Density Bill Passes California Legislature
SB 1538, a state bill to require California physicians to inform patients who have dense breasts, has passed the state Senate on a unanimous vote of 36 to 0. Now advocates for the bill have only one more hurdle to leap: Governor Jerry Brown, who last year vetoed similar legislation, must sign the bill for it to become law. Last year, Governor Brown wrote that he vetoed the legislation, not because he did not believe women had a right to know if they had dense breast tissue or not, but because the proposed legislation also mandated that women with dense breast tissue be advised that additional screening may be beneficial. SB 1538 uses more tempered language than last year’s legislation.
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OCTOBER
2012 RBMA Fall Educational Conference
Sponsored by the RBMA
October 7–10
Sheraton Wild Horse Pass Resort
Chandler, Arizona
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Economics of Diagnostic Imaging 2012
Sponsored by ESI Educational Symposia
October 24–28
The Ritz-Carlton, Pentagon City
Arlington, Virginia
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NOVEMBER
RSNA 2012: Patients First
Sponsored by by the RSNA
November 25–30
Chicago, Illinois
Register >>
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