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THE BIG PICTURE
Reflections
By Curtis Kauffman-Pickelle
Here we are at the end of yet another tumultuous year in the health-care arena—perhaps one even more tumultuous than most. There are new laws, new expectations, revised plans, and lots more to write about as we face the consequences—intended and otherwise. Having just returned from the annual gathering of the imaging clan that is RSNA, I am pleased to report that optimism generally prevailed. I have been involved in this conference/event for many years, and during that time, I have seen my fair share of doom and gloom. This was not one of those years. In case you missed it, you can review the excellent real-time reporting from the convention by our Cat Vasko by going to imagingbiz.com/statread.
One development worth mentioning is our personal RSNA experience this year. As I entered the exhibit hall at around 9:45 on Tuesday morning, I took a call from my police-officer brother-in-law back home, informing me that our office building was completely engulfed in flames. Within an hour, our office (along with the offices of several other businesses in our two-story complex) was reduced to a smoldering pile of rubble. Thirty years’ accumulated things had disappeared into that pile.
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New CMS Rules Complicate Supervision and Interpretation
By Rich Smith
 Recently altered CMS rules governing diagnostic-imaging supervision and interpretation agreements have created what one knowledgeable observer calls a horrible mess. Health-care attorney Tom Greeson, a partner in the law firm Reed Smith LLP of Falls Church, Virginia, expresses concern that regulatory changes that took effect earlier this year might cause confusion among imaging centers and radiology groups that provide interpretation services across state lines.
For starters, “CMS has changed the rules dramatically by eliminating the concept of purchased interpretations,” according to Greeson, whose practice focuses on Medicare reimbursement and on legislative and regulatory issues. Purchased interpretations, he indicates, have been superseded by antimarkup tests and so-called reassigned professional services.
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Reimbursement Outlook for 2011: Trouble on the Way
By Cat Vasko
 On November 30, the Physician Payment and Therapy Relief Act of 2010 was signed into law, delaying the 23% Medicare physician-payment cut mandated by the sustainable growth rate formula. The legislation replaced the cut with a 2.2% update through December 31, with the intention of giving Congress time to find a more permanent solution. On December 8, that solution appeared to have been reached, with the passage, by Congress, of legislation that would extend current reimbursement rates through 2011.
The legislation, if passed, could represent a small bright spot in what is otherwise a difficult reimbursement environment for imaging. The bill would subsidize its 2011 payment update—the cost of which is estimated at $14.9 billion over 10 years—through a modification to the PPACA health reform legislation involving the provision of tax credits to those with incomes between 100 and 400% of the federal poverty level; the change, which marks the first substantial modification to health care reform passed by Congress, would require tax credit recipients who misstate their income or experience a change in income over the course of the year to repay part of the subsidy.
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Matching Imaging Purchases With Patient Demographics: WellSpan Health
By Julie Ritzer Ross
While traditional closed MRI systems continue to offer a multitude of benefits, competition and a growing population of patients who cannot tolerate them make a closer look at alternative modalities warranted, according to Ronald F. Bernardi, FAHRA. He presented “Know Your Market to Grow Your Market” on August 24, 2010, at the annual meeting of AHRA: The Association for Medical Imaging Management, in Washington, DC (and later provided additional details). 
These catalysts led York, Pennsylvania-based WellSpan Health (where Bernardi serves as director of imaging services for York Hospital) to install a 1.2T boreless MRI unit from Hitachi Medical Systems America Inc http://www.hitachimed.com/ (Twinsburg, Ohio) in February 2010. The unit, Bernardi states, allows the health-care provider to offer imaging services that better correlate with patient demographics and overall business strategies, thereby fostering growth.
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Interpreting From Multiple Facilities: The Case for a PACS-driven Workflow
By Cat Vasko
 For the first five years of its existence, Tower Saint John’s Imaging, a full-service outpatient imaging center in Santa Monica, California, that is a joint venture between Saint John’s Health Center and Tower Imaging Medical Group, used its own RIS, PACS, and speech-recognition products separate from those of Saint John’s Health Center. The same radiologists interpreted studies from both sites, but the integration of patient care between the imaging center and the hospital was not optimal, according to Gerald Roth, MD, president and CEO of Tower Saint John’s Imaging.
When the PACS at the hospital began to fail, and the facility began to consider a replacement PACS, Roth recognized an opportunity to improve the delivery of imaging services through a unified PACS.
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NLST Proves Lives Can Be Saved: Now Comes the Difficult Step of Implementation
By George Wiley
 One of the most extensive and ambitious medical-screening trials in US has been stopped. It’s because of good news: Low-dose helical CT (LDCT) exams can cut lung-cancer deaths by as much as 20%, compared with chest radiography alone, according to early results from the National Lung Screening Trial (NLST). The NLST was halted in early November, 2010, after researchers determined that a 20.3% reduction in mortality rates occurred among patients examined using LDCT, compared with mortality rates among patients who underwent conventional chest radiography.
The trial lasted eight years and included nearly 53,500 participants between the ages of 55 and 74 who were asymptomatic current or former smokers, each with at least 30 pack-years of cigarette consumption prior to enrolling in the study.
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Business 101: Communication and Information Sharing in Radiology
By Cat Vasko
This article is the final installment in a four-part series on applying basic business concepts to radiology. To read the first installment, click here; to read the second, click here; to read the third, click here.
 
To avoid succumbing to the tyranny of the majority in making business decisions, Dan Simile Jr and Greg Thomson of Medical Management Professionals, Inc (MMP), Atlanta, Georgia, recommend that radiology groups establish annual wildly important goals (WIGs) and make meeting those goals a practice-wide priority. Equally important, however, are the communication and information sharing that not only enable leaders and staff to track the execution of these goals, but also help them achieve the goals in the most efficient and informed manner possible.
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INFORMATION RESOURCES
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Assessing the Nonmedical Expense of CTC: Study
A study in the December issue of Journal of the American College of Radiology: JACR attempts to assess the nonmedical costs of screening for colorectal cancer (CRC) using CT colonography (CTC). Nearly 500 participants in CTC screening in Canada were questioned about their expenses related to the exam, including travel costs and time off work. The authors conclude that “the nonmedical costs of CRC screening using CTC are significant, but lower than those of colonoscopy” and that differential costs “should be incorporated into economic analyses of CRC screening.”
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Speech Recognition’s Success Varies
According to a study conducted at the University of North Carolina, Chapel Hill, improvements in report-turnaround time when using speech-recognition software are dependent on a human element. In the November issue of RSNA News, the study’s coauthors note that improvements in turnaround time are correlated with individual work habits, with those radiologists who reviewed, revised, and finalized reports at the time of image review improving most. “When you change the manner in which you are generating and signing reports, it causes a lot of disruption,” according to lead author Arun Krishnaraj, MD. “Even those who did well . . . were fighting the system somewhat in the beginning.”
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Image Wisely Campaign Launches
On November 29, at the annual RSNA meeting in Chicago, Illinois, the ACR®, RSNA, and other groups jointly launched a new campaign, Image Wisely, aimed at encouraging imaging providers to optimize adult radiation exposure. The campaign will initially focus on CT scans, of which 87 million were performed in 2009, according to the ACR. Educational and research materials are available at the campaign’s website, imagewisely.org, where patients can also download a My Medical Imaging History card to help them track radiological exams over time.
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Congress Pushes Back SGR Cuts—Again
On December 8, Congress passed legislation to delay, yet again, the decrease in Medicare physician-payment rates mandated by the sustainable growth rate formula. The bill would delay the proscribed 23% cut through 2011, and is paid for through a provision that would change part of the health care reform legislation that provides tax credits to people with incomes between 100 and 400% of the poverty level. The measure mandates that current reimbursement rates continue through 2011, and also extends several expiring Medicare programs, including protections for rural doctors and hospitals, according to the ACR.
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COMING EVENTS
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JANUARY
Leadership Strategies for Radiology: Taking Your Practice to the Next Level
Sponsored by ACR Executive Leadership Series
January 30–February 4, 2011
The Sebastian Vail, Colorado
This intensive symposium will present a comprehensive series of lectures focused on developing attendees’ leadership skills and optimizing the structure and function of their practices.
[Register]
FEBUARY
HIMSS11 Annual Conference and Exhibition
Sponsored by Healthcare Information and Management Systems Society
February 20–24, 2011
Orange County Convention Center Orlando, Florida
Health care’s largest IT event will feature keynotes, education, and exhibits on a broad spectrum of health-care IT topics.
[Register]
MARCH
Building Better Radiology Marketing Programs
Sponsored by RBMA
March 20–22, 2011
Portland Marriott Downtown Waterfront Portland, Oregon
This comprehensive seminar featuring peer-to-peer learning will help radiology marketers develop fresh and innovative programs. The 2011 RBMA Quest Awards will also be presented.
[Register]
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Subscribe now to radiology's next-generation economics journal
Coming in the February/March Issue
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