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THE BIG PICTURE
The One With the Most Data Wins
By Curtis Kauffman-Pickelle
 Well, almost: Virtually every practice or hospital has tons of raw data. Getting data is not the issue. The real issue is having the knowledge and skill to interpret the data and develop strategies based on the stories told deep within data catacombs. This is what separates level 5 performers from the crowd.
Increasingly, referral-dependent health-care providers of all types are facing unprecedented levels of competition and pressure to outperform those intent on encroaching on their turf. The concept of the boundaryless enterprise is taking root in every region, often with remarkable effectiveness. The result is that the old rules of engagement have changed drastically. Just a few short years ago, it would have been unheard of for the once predictable, somewhat genteel practice of radiology to morph into a constantly tense and unpredictable beast, often lashing out in a crisis-management, reactive way.
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Building a Distributed-reading Solution: Sunshine Radiology
By Cat Vasko
Sunshine Radiology was facing a quandary familiar to many radiology groups. The busy 25-radiologist practice (based in Sebring, Florida) wanted to expand its hospital business, but knew that it needed to lower its costs in order to do so. “We needed to keep our radiologists as efficient as possible, and there wasn’t always enough volume to support having a radiologist on-site at each hospital,” Shawn Zimmerman says.
 Zimmerman is an IT specialist for Sunshine Radiology and CEO of allRadiology Solutions LLC of Winter Haven, Florida, which provides IT support for Sunshine Radiology. He explains, “With Medicare reimbursement being lowered, there’s a lot more pressure to keep costs low. We’re trying to use technology to create the efficiencies we need to lower our costs and pass those on to our hospitals.”
Sunshine Radiology currently reads for five Florida hospitals, and is in the process of bringing on an additional three hospital clients. The practice plans to accommodate the new volume using a distributed-reading solution that will enable its radiologists to read off-site for all of its hospital customers. “We can make better use of our radiologists this way,” Zimmerman notes. “Instead of paying five radiologists’ salaries to cover, for instance, the 11 pm–7 am timeframe, we can take one salary and split it.”
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Regulatory Update: October 2010
By Jane Cys
The FDA’s review process for medical devices still needs clarification, and the link between user fees and performance needs strengthening, representatives of medical device manufacturers testified at a public hearing.
The FDA held the public hearing in September before beginning its update of the Medical Device User Fee and Modernization Act (MDUFMA), which is up for renewal in 2012. The law imposes user fees on medical-device companies in order to provide the FDA with sufficient resources to review the safety of medical devices and approve them in a timely manner. The act was first passed in 2002, and it was renewed for a five-year period in 2007.
Dave Fisher, executive director of the Medical Imaging & Technology Alliance, says, “The general perception, among our members, is that the link between user fees and FDA performance is broken.” Medical-device companies provided nearly $300 million in user fees between 2008 and 2010 to help fund the program.
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Provider-based Restructuring: Approach With Caution
By Cat Vasko
Freestanding imaging has come under fire in recent years, with a series of Medicare Physician Fee Schedule reimbursement cuts decimating revenue. Hospital-based imaging, on the other hand, has not absorbed as much impact, a reflection of the aligned-care model promoted by President Obama during the development and passage of health-reform legislation.
 Freestanding imaging centers (either owned in part or wholly by radiologists) might, therefore, be considering provider-based restructuring as a means of capturing higher Hospital Outpatient Prospective Payment System and commercial payor reimbursement rates, but is this always the best option? Richard Townley, president and CEO of AGI Healthcare Group, San Ramon, California, advises both practices and hospitals to approach these arrangements with caution.
“One size doesn’t fit all,” Townley says. “Provider-based restructuring that might make sense in one market might not make sense in another.” Reimbursement benefits need to be weighed against the administrative and clinical requirements of a hospital-based service, the competitiveness of the local market, and the priorities of the deal’s participants. In general, provider-based restructuring stands the highest chance of succeeding in markets where the imaging center isn’t facing much competition from freestanding centers, Townley says. There are, however, other nuances to be considered, ranging from the location of the imaging center to its preferred governance structure.
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Know the Market, Grow the Market: St Joseph Mercy Hospital
By Julie Ritzer Ross
In today’s business environment, it is critical for health care organizations and their leaders to demonstrate a thorough understanding of their respective markets’ dynamics, needs and demands—and to make decisions accordingly, said Donna Wade in the “Know Your Market to Grow Your Market” session held on August 24 at the annual meeting of the AHRA: The Association for Medical Imaging Management, in Washington, DC. It was this concept that led Wade, who is MRI coordinator at St. Joseph Mercy Hospital Ann Arbor (Superior Township, Michigan), and her colleagues to select a 1.2T bore-less MRI unit for their facility rather than a traditional closed MRI system. This decision, Wade says, helped St. Joseph Mercy sharpen its competitive position in the marketplace, meet the needs of its respective service area populations, and, ultimately, achieve even greater
volume growth than expected.
 St Joseph Mercy Hospital Ann Arbor is part of St Joseph Mercy Health System, which operates seven hospitals, holds a license for 1,726 beds, has a medical staff of nearly 2,700 physicians, and also maintains a network of outpatient sites that includes two facilities where cancer treatment and surgical services are provided. Founded in 1911 in downtown Ann Arbor and relocated to Superior Township in 1977, St Joseph Mercy Hospital Ann Arbor is licensed for 537 beds, has a 341-acre campus, and employs more than 6,500 people.
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The Next Generation of Outsourced Billing
By Cat Vasko
The decision to outsource billing is one faced with increasing regularity by radiology groups seeking to trim costs while maximizing reimbursement. Within this larger decision also lies another conundrum: how to select the outsourced-billing approach that best suits the practice. Kevin Shepherd is chief development officer for Medical Management Professionals (MMP), Atlanta, Georgia. He says, “Outsourcing is generally going to be less expensive. You’re going to save money, but the decision can become more complex, depending on whether you outsource off-site.”
Outsourcing in its most recent iteration, however, can provide practices with the control they want, Shepherd says, as well as advantages made possible by next-generation billing technology for data analysis and benchmarking. “The biggest argument for in-house billing is control, or perceived control,” Shepherd says. “When we work with groups, one of the key things we tell them is that this doesn’t mean we’ll make decisions for them. Instead, we get them the data they need to make their own decisions, and if they want, we add our advice.”
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How Radiology Volumes Impact Revenue
By Cat Vasko
Four community hospitals, each located in a non-metropolitan area, sought to improve their radiology service. Each began to see improvements within about six months, and the gains were accomplished, for the most part, without adding new or better modalities.
 The explanation, according to Clayton Larsen, senior vice president of client and network development at Radisphere National Radiology Group (Beachwood, Ohio), is that the hospitals focused almost entirely on improving their quality and service levels; it was this initiative that resulted in a favorable shift of local referral patterns. Referring physicians gradually shifted cases to the hospitals for imaging instead of to their freestanding imaging center competitors, he says.
Equally significant, Larsen says, is that total volumes for more highly reimbursed, high-tech CT and MRI studies did not appear to grow dramatically at any of the four facilities; in some cases, there was flat to modest growth in these modalities. However, when a more in-depth analysis was performed, a subtle but more compelling story emerged, according to Larsen. “Hospital-based outpatient-imaging operations typically suffer in the marketplace because the nonhospital competition is perceived as offering better service—everything from more convenient patient scheduling to easier physical access,” Larsen notes. “The frustrating part, for hospitals, is that physicians don’t need to look any further to obtain a high-quality product.”
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Member of the following organizations:
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INFORMATION RESOURCES
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Medical Students Embracing IT: Survey
According to the fifth annual Future Physicians of America survey, a poll of over 700 medical students conducted by reference-software vendor Epocrates, medical students are far more IT-reliant than ever before. Students are twice as likely to turn to mobile references as 2009 respondents were, and 70% of those polled say that technology will be an important factor in determining where they will practice medicine.
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Measuring Productivity in General Radiology
Research in the October issue of the Journal of the American College of Radiology: JACR looked at the results of measuring productivity among general radiologists in a moderate-sized hospital. Although group productivity was rated at 50% at the beginning of the study, the authors found that it increased, during the first year of monitoring, to as much as 63%, resulting in estimated cost savings of $174,000. “This methodology, if widely adopted, could be standardized and used to compare productivity across departments and institutions,” the study concludes.
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ACR and ARRS Restructure Integration
On September 30, the ACR® and the American Roentgen Ray Society announced a restructuring of their strategic integration, aimed at serving the organizations’ respective memberships more directly. The two associations will continue to act under separate governance structures, but will be able to carry out certain services for each other if increased impact or efficiency might be achieved, the ACR says. The restructuring will be carried out over the next several months, and the organizations will update members on any major developments as they occur.
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Physician and Specialist Shortages to Continue: AAMC
The Association of American Medical Colleges (AAMC) anticipates a shortage of 45,000 primary-care physicians and 46,000 surgeons and medical specialists over the next decade. The AAMC says that the shortage will be driven by coverage expansions mandated by health-care reform, as well as by the aging of the population, and it is calling for the lifting of the 1997 freeze imposed by Congress on Medicare-supported residency positions. “Unless the number of residency-training positions expands at the nation’s teaching hospitals, the United States will face a declining number of physicians per capita just as the baby boomers swell the Medicare rolls,” the college says.
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Acquisition Protocols for Quantitative Imaging: Coming Soon
The most recent issue of RSNA News looks at the development of quantitative imaging protocols by RSNA's Quantitative Imaging Biomarkers Alliance (QIBA) and other groups. The aim of the protocols is to improve the reproducibility of numerical data from scans. Daniel Sullivan, MD, QIBA’s chair, says that clinicians can soon expect to use PET and CT profiles and protocols in clinical trials—and possibly in clinical practice. "Quantitative MRI is a little more complicated, so those protocols probably won't be ready this year," Sullivan notes.
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COMING EVENTS
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OCTOBER
2010 ASTRO Annual Meeting
Sponsored by the American Society for Radiation Oncology
October 31–November 4
San Diego Convention Center San Diego, California
ASTRO’s 2010 Annual Meeting will feature various educational symposia and CME activities for physicians, physicists, technologists, dosimetrists, and nurses. This year’s conference is ASTRO’s largest scientific program ever, with sessions on patient safety, quality improvement, efficacy, and the challenges of practicing medicine in the evidence-based era.
[Register]
Economics of Diagnostic Imaging 2010
Sponsored by ESI Educational Symposia
October 27–31
The Ritz-Carlton Pentagon City Arlington, Virginia
The 2010 EDI meeting will focus on strategies for success in the changing radiology market, focusing on issues that include utilization management, hospital negotiations, compliance and coding, pay for performance, and more.
[Register]
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.”
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