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The Big Picture
Is the Price Right?
By Curtis Kauffman-Pickelle
 On October 9, at the RBMA 2012 Fall Educational Conference in Chandler, Arizona, I had the honor of moderating a panel discussion, “Is It Time to Buy, Hold, Sell, or JV?” The faculty participants discussed the very nuanced art and science of building a success strategy for the potential transactions—merger, sale, alliance, joint venture, and so forth—that imaging executives might be pondering. It was a wide-ranging discussion that included some incredible advice from seasoned experts on the key elements to be included in a winning strategy for any negotiation that involves maximizing asset valuation.
Cat Vasko, ImagingBiz editor, posed several relevant questions to panelists Todd Sorensen, partner with valuation company VMG, and Doug Smith, head of the strategic consulting division of Integrated Medical Partners. These two thought leaders offered general-session attendees a glimpse of how imaging executives can take full advantage of the existing deal climate while making the best decisions for their respective organizations.
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Radiology and the ACE: Reports From the Front Lines
By Cat Vasko
Neale Pashley, operations manager for Medical Management Professionals (MMP), found himself on the front lines of the CMS Acute Care Episode (ACE) Demonstration when a radiology practice with which he worked became a participant. “What the radiology industry should prepare for, more than anything else, is the impact this might have on utilization,” Pashley says. “The goal is to cut down on unnecessary utilization of procedures, and while the initial impact might be limited, over time, that will change.”
The current ACE Demonstration, announced by CMS in 2009, took place at five hospital sites that agreed to be paid a single sum for all Part A and B services for Medicare inpatients (a five-year pilot, set to begin in 2013, will also look at payment bundling for postacute services in a variety of settings). The ACE pilot raised questions about the role of specialists (such as radiologists) who contract with hospitals.
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Streamlining Portable Radiography Efficiency: HUP
By Cat Vasko
Valerie Ciminera, a manager in radiology at the Hospital of the University of Pennsylvania (HUP) in Philadelphia, describes the large facility as comparable to a small city, with a lot of ground to cover between buildings. The department of radiology at HUP uses 10 analog portable radiography systems to image an average of 225 inpatients per day at bedside, she says, and most of the studies are stat requests: Within 45 minutes, the technologist is required to go to the bedside, acquire the images, process them, and submit them for a radiologist’s review.
“A large majority of the patient population is critically ill, so turnover time for these studies is time sensitive for diagnosis,” Ciminera notes. “Needless to say, our technologists are moving all day long.”
Ciminera says that HUP is loyal to its current portable systems, some of which have been in service for more than 15 years. “Our portable units are a huge asset, due to the simple fact that they are so dependable—which is necessary, with our volume,” she says. The radiology department wanted to improve its bedside-radiography efficiency, with the ultimate aim of facilitating better patient care, but upgrading to portable DR systems, Ciminera notes, “would not be cost effective for an institution of this size.”
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Eight Trends With an Impact on the Practice of Radiology
By Maril Hazlett, PhD
 It’s no longer business as usual. That was the main message that radiologist and consultant Lawrence R. Muroff, MD, FACR, brought to the California Radiological Society’s 2012 Annual Meeting & Leadership Summit in San Francisco. On September 9, he presented “Future Trends That Will Impact What You Do and What You Earn,” highlighting eight major trends affecting radiology practices today—as well as four nightmares that they might face in the future.
“The future of radiology is bright, but the future for radiologists is uncertain,” Muroff says. “What we have now is not guaranteed. Some people will thrive in the future, while many will be caught unprepared. Turbulent times offer unprecedented opportunity, and you’re going to have to decide on which side of the equation you will be found.”
Muroff says that part of the reason that so many radiologists are unprepared is that the profession tends to predict the future based upon past performance—when in fact, the future will include radical change. Radiology practices are caught up in major transitions due to both external and internal factors. With health-care reform, radiologists have, Muroff says, “taken it on the chin,” but the specialty’s difficulties are not all due to the federal government. Radiologists are often their own worst enemies: “We are also responsible for our own problems,” he says.
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Business Basics for Radiologists: Net Present Value
By Cat Vasko
 At the 2012 Annual Meeting & Leadership Summit of the California Radiological Society in San Francisco, Frank Lexa, MD, MBA, presented “Core Financial Principles for Radiology Professionals” on September 8. According to Lexa, who is vice chair and professor of radiology at Drexel University College of Medicine, using certain financial tools (such as modeling) is among, he says, “the core things you have to do, as a leader, to decide whether something makes financial sense.”
He notes that many radiologists in practice make excuses for not understanding finance—and that these excuses are not valid. “People who can manage their financial systems well tend to be better radiologists,” he says. “You really do have to have expertise—and you, as radiologists, have a tremendous amount of insight that people outside our area don’t have.”
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Radiology Groups Grow Business with InteleOne: KLAS Report
By Cat Vasko
 The vendor-research company KLAS is perhaps best known for its market reports, which compare the performance of multiple vendors in a single product category. Recently, however, the company has introduced a new approach to its reports that is reflective of the growing need to evaluate emerging technologies prior to widespread adoption and competition. Ben Brown, imaging and medical-equipment researcher at KLAS, says, “There has to be enough adoption across multiple similar products for us to talk to enough people to compare them, so we started to look at how we could have an impact on the earlier end of the bell curve (and help providers sooner) by getting insights that
are still relevant and unbiased.”
The KLAS provider advisory board approved the idea of evaluating individual products, as long as the company’s researchers could ensure the same unbiased and transparent reporting. “They said they would love to get their hands on information about tools that would help them increase quality, improve patient care, and cut costs,” Brown says. “We think these reports may help as much as 60% to 70% of the market because they will allow people to hear from early adopters.”
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HIMSS Opposes House Republicans’ Demand to Suspend Meaningful Use Incentives
Congress has largely stayed out of the development of the incentive program to encourage adoption of electronic health record (EHR) systems by providers, but when four leading House Republicans did weigh in, they did not mince words and drew a sharp response from the Healthcare Information and Management Systems Society (HIMSS). In an October 4 letter to Health and Human Services Secretary Kathleen Sebelius, Republicans Representatives Dave Camp (Mich.), Fred Upton (Mich.), Wally Herger (Calif.) and Joe Pitts (Pa.) expressed strong concern that the Stage 2 Meaningful Use regulations do too little to encourage true interoperability between different EHR systems and waste taxpayer dollars by handing out incentives to providers who have invested in EHR systems that “cannot talk with one another.”
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2013 OIG Work Plan Includes Focus on Imaging Practice Expenses and Medical Necessity
The Office of Inspector General has released its priorities for finding fraud and waste in Medicare and it once again includes imaging services. According to the 2013 OIG Work Plan, it will specifically focus on two areas of diagnostic imaging. The first is the appropriateness of current practice expense payments for selected Part B imaging services. The OIG also plans to look closely at the medical necessity of “high-cost” diagnostic radiology tests and review whether there is a difference between primary care physicians and specialists in how often they order the same diagnostic tests for the same treatment.
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Radiologists Develop New Guidelines for Managing Acute Low-Back Pain
Treatment for acute low-back pain is one of the most common reasons for outpatient physician visits and inconsistencies in how this symptom is treated are often blamed for waste in health care. In the October issue of the Journal of the American College of Radiology: JACR, radiologists at Emory University Hospital in Atlanta and Georgia Health Sciences University in Augusta, Ga., offer a solution. The radiologists developed a set of evidence-based guidelines suitable for inclusion in decision support systems that could assist physicians with managing patients with acute low back pain.
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ASTRO Pulls Out of Joint Practice Accreditation with ACR
The Board of Directors of the American Society for Radiation Oncology (ASTRO) has decided not to continue in a joint practice accreditation program with the American College of Radiology (ACR) and is no longer affiliated with that program. Citing an inability to come to agreement with the ACR on some major components of a partnership, ASTRO is ending its affiliation with the ACR radiation oncology accreditation program and instead plans on launching its own program. ASTRO anticipates that its accreditation program will be ready sometime in mid 2013. Facilities currently scheduled for an accreditation survey should contact the ACR with questions, ASTRO said.
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OCTOBER
Economics of Diagnostic Imaging 2012
Sponsored by ESI Educational Symposia
October 24–28
The Ritz-Carlton, Pentagon City
Arlington, Virginia
Register >>
NOVEMBER
RSNA 2012: Patients First
Sponsored by by the RSNA
November 25–30
Chicago, Illinois
Register >>
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