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The Big Picture
When Elephants Dance
By Curtis Kauffman-Pickelle
 Over the past year, I have written about some of the key indicators pointing to a maturing of the medical-imaging marketplace. Among these is the fact that consolidation is accelerating across virtually all sectors of the profession: radiology groups, hospitals, health systems, vendors, and payors. Consolidation not only is a factor that affects business decisions in these segments, but is an overarching issue that is changing the already-complex health-care landscape in ways that are having a significant impact on the imaging executive’s ability to stay ahead of the game.
A case in point is an emerging situation in Pittsburgh, Pennsylvania, that was the subject of an article¹ in the March 27 issue of the Wall Street Journal. The article focuses on the impact on patients of a major turf battle between the University of Pittsburgh Medical Center (UPMC) and Highmark; the provider–payor relationship that is under major stress due to Highmark’s efforts to acquire West Penn Allegheny Health System (Pittsburgh). There are significant patient-access and care implications, but there are just as many business implications for those who happen to be in close proximity to these dancing elephants.
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Optimizing Interventional Care at UMMC: A Case Study
By Cat Vasko
 Interventional-radiology departments are facing increasing demands to justify costs, measure outcomes, and prove value in a competitive clinical environment. Though they are often managed alongside their diagnostic-radiology counterparts, the reality is that interventional-radiology departments have more in common with cardiac catheterization, electrophysiology laboratories or endoscopy than with diagnostic-radiology departments, according to Jeff Knox, MS, RT(R)(CV), CRA, director of operations and asset manager for the department of radiology at the University of Maryland Medical Center (UMMC), Baltimore.
 “Diagnostic radiology is very transactional, by comparison,” Knox says. “Interventional radiology is much more patient centered. It’s a continuum experience: Some of the patients are seen in our outpatient clinic by a radiologist; the patients are always assessed pre-procedure by a nurse, physician’s assistant, nurse practitioner and/or a radiologist; post-procedural care and instructions are given; and some patients have follow-ups in our outpatient clinic.”
Fifteen years ago, the interventional-radiology department at UMMC implemented an informatics solution developed by the Society of Interventional Radiology and aimed at streamlining the complex processes inherent in handling a high volume of interventional procedures. The HI-IQ product, now distributed by ConexSys, enabled the department to manage its outpatient scheduling and inventory better.
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The Impact of Industry Trends on Imaging-center Valuation
By C. Elliott Jeter, CFA, CPA/ABV, and Colin McDermott, CFA, CPA/ABV
  Over the past few years, hospitals have been acquiring imaging centers at a brisk pace. Hospital and imaging-center transactions require an independent opinion on fair market value to ensure regulatory compliance; a thorough fair-market analysis will incorporate macroeconomic industry trends, along with the facts and circumstances specific to the individual center.
In 2011, Radiology Business Journal and SDI Health LLC published the results of their second annual survey¹ illustrating trends related to the top 20 imaging-center chains and the larger environment in which they operate. The data in this survey can assist the valuation analyst in formulating a basis for the future financial performance of a center that is used in the income approach (discounted–cash-flow) methodology of valuation. The industry information also assists the valuation analyst in determining the velocity, pricing, and strategic motivation behind comparable transactions within the industry, and can be very helpful when preparing an analysis of fair market value.
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RAC Expansion: How Radiology Practices Can Prepare
By Cat Vasko
 In 2007, CMS implemented a new program aimed at eliminating fraud and abuse: the use of Medicare recovery audit contractors (RACs). Under the RAC program, independent contractors look for improper Medicare payments in exchange for a percentage of the overpaid or underpaid dollars discovered, resulting in a high level of scrutiny for Medicare reimbursement.
 Ed Gaines, vice president and chief compliance officer for Medical Management Professionals, Inc. (MMP), says, “RACs, even in their earliest stages, saved a lot of money.” In fiscal 2011 (ending September 30), the Medicare Part B RACs collected more than $900 million, including adjustments for underpayments. As a result, Gaines says, expansion of the program to Medicaid and Medicare Advantage plans was a natural move for Congress to undertake when attempting to justify the cost of the Patient Protection and Affordable Care Act (PPACA). “The RAC program was scored by the Congressional Budget Office as savings billions on Medicare, and those predicted savings
offset the significant costs of the PPACA,” he says.
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PACS and the iPad: Possibilities and Potential
By Matthew Skoufalos
 It’s more than a truism to discuss mobile computing as the next horizon in the delivery of health care. Today, the achievements of such systems are measured in degrees of eventuality, rather than possibility; their potentials are gauged in whens, not ifs.
The landscape for such products, though, is far from conquered. In the imaging world, the next great barrier to overcome involves synchronizing the capabilities of mobile devices with the needs of the infrastructure that stores, transports, and accesses massive amounts of highly sensitive patient data.
The business case for such products revolves, in large part, around the convenience that it affords primary-care practitioners, according to David Hirschorn, MD, director of radiology informatics at Staten Island University Hospital in New York. “The hand that feeds us is an ordering clinician,” Hirschorn says, “and clinicians use personal and mobile devices. That’s how they want to see their patients’ data, and those include images.”
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Completing the MRI Portfolio: Summa Health System
By Cat Vasko
 Summa Health System (Akron, Ohio), one of the largest health-care networks in the state, was facing a difficulty common to organizations that provide imaging for bariatric patients: the 0.3T open MRI system at its Summa Health Center at White Pond, to which many of these patients had to be referred, was too low in field strength for certain types of exams. Nancy Lawson, Summa Health System’s manager of radiology ambulatory services, says, “We needed an open unit that was also a high-field system, for orthopedic and abdominal work, in particular.”
The need was especially strong because of Summa Health System’s Bariatric Care Center, which draws a higher proportion of overweight patients than many organizations see. The Bariatric Care Center offers a program for medical weight-loss management and weight-loss surgery, and the latter can necessitate imaging. “The low-field system did not offer the same image quality that a high-field unit has,” Lawson says. “Within the health system, we have high-field units, but they are 1.5T closed units or closed large-bore high-field systems.”
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Modeling Obese Imaging Phantoms, Researcher Finds Higher Dosages Likely
More than one-third of all Americans are obese, and yet most medical imaging equipment is not designed to accommodate them. This fact also underscores the likelihood of their increased exposure to ionizing radiation, says new research reported in the journal Physics in Medicine & Biology. By mathematically developing a pair of gender-specific phantoms that reflect more accurately the composition of an obese man and women, respectively, a nuclear engineer at Rensselaer Polytechnic Institute concluded that people with larger body types would absorb about 60% more radiation on average than a person of normal weight.
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Will New PET-CT Biomarker Help ID Alzheimer’s?
In the rush to tout Amyvid, the amyloid-plaque-seeking biomarker created by Eli Lilly, as a diagnostic breakthrough in the treatment of Alzheimer’s disease, some are urging caution—including the Alzheimer’s Association. Amyvid was just approved by the FDA on Friday, yet that celebration was tempered by the refusal of CMS to approve coverage for its prescription. The drug carries a significant warning that it is incomplete as a standalone diagnosis mechanism, and its own founders reported in the University of Pennsylvania student newspaper that Amyvid can bind to other, unintended particles, complicating the read of the PET scan.
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“Choosing Wisely” Highlights Opportunities to Improve Utilization
can eliminate financial waste and unnecessary testing, says an ACR fellow who worked on the American Board of Internal Medicine Foundation Choosing Wisely campaign. “We’re trying to make patients and physicians comfortable with the idea that having more tests is not always the best way,” says Debra Monticciolo, MD, FACR. Monticciolo says the intention of Choosing Wisely is to initiate a dialogue among specialists, referring physicians, and their patient groups to take a more informed interest in treatment where non-specific, non-acute issues are involved.
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AHRAdatalynx to Drive Improvement through Competition
In what its developers are calling a 21st-century upgrade for the organization, AHRA: The Association for Medical Imaging Management has automated and digitized its annual member survey via a comprehensive data tool that could drive performance improvement industry-wide. AHRAdatalynx is an analytical benchmarking tool derived from a partnership between the professional group and National Imaging Network. With the participation of hundreds of AHRA members nationwide, imaging professionals will be able to see where their practices stand in relation to their cohorts in the field.
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MAY
Radiology and Imaging Conference 2012
Sponsored by Health Connect Partners
May 9–11
Hyatt Regency
Miami, Florida
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2012 Radiology Summit
Sponsored by the RBMA
May 20–23
Loews Royal Pacific Resort at Universal
Orlando, Florida
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JUNE
SIIM 2012 Annual Meeting
Sponsored by the Society for Imaging Informatics in Medicine
June 7–10, 2012
Orlando, Florida
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International Symposium on Multidetector Row CT
Sponsored by the International Society for Computed Tomography
June 17–20
Hyatt Regency
San Francisco, California
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