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The Big Picture
Radiology’s Role in Changing the Culture of Medicine
By Cat Vasko
 Well, it happened: In a surprise ruling, the Supreme Court upheld the constitutionality of health-care reform by interpreting the individual mandate as a tax. The full decision is well worth reading, but the upshot is that starting in 2015, our already beleaguered—some would say broken—health-care system will take on up to 30 million additional patients, depending on how you estimate the ranks of the uninsured and how many of the uninsured decide that it’s worth buying insurance and dodging the penalty.
For radiology, as many have already noted, the direct impact of this change might be small, at first; after all, the bulk of the currently uninsured are young, healthy patients who wouldn’t require much imaging anyway. Bracing ourselves for a fresh influx of patients, however, does underscore perennial questions about the utilization and management of health-care resources, as well as the evidence base for many all-too-common procedures and interventions. These questions always should have been of urgent importance to us—but now, they are more pressing than ever before.
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Collaborative Care: Radiologists’ Involvement in Real-time Diagnosis
By Gerald R. Kolb
 One trend, in medicine, is for primary-care and specialty physicians to use ultrasound—and, perhaps, other imaging modalities—in their practices. From my perspective (and with 20 years of experience as an imaging and hospital administrator and consultant, US medicine is evolving away from fee-for-service reimbursement and toward outcomes-based payment for patient care. Both imaging and the way we use imaging are rapidly changing, and we should think about how to use imaging in the most effective manner.
Only 25 years ago, both CT and MRI were rare and in their infancy, ultrasound was crude, and the vast majority of radiology involved plain radiography or some variant of radiographic technology. It took the development of inexpensive computing power to drive the radiology technologies that we have today. Because of the relatively limited scope of radiology in 1980, however, the primary-care physicians and specialists of that time could have a reasonable command of which imaging study to order in a particular episode of clinical care.
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Strategies for Managing Payment From Self-after Patients
By Cat Vasko
 Thanks to the June 28 Supreme Court decision, one problem that radiology practices might not face for much longer is managing payment from uninsured patients—an issue that currently plagues hospital-based groups, in particular, according to Krista Pelensky, director of operations with Medical Management Professionals (MMP). “Many hospital-based groups have seen an uptick in uninsured business and an increase in emergency-department services,” she says.
Even if this problem is mitigated by health-care reform’s individual mandate, however, there is a second, and growing, category of self-payment with which radiology groups must contend. This category consists of self-after patients: those whose copayments, deductibles, and other out-of-pocket contributions to the cost of their care have become so high that paying their bills after service is rendered can be burdensome—as are collections, for the radiology group.
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Current Factors Influencing Outpatient Imaging Valuation
By Todd Sorensen, AVA
 Evidence suggests that imaging utilization declined between 2009 and 2011, particularly for the high-tech modalities, including CT and MRI. Data1 from Regents Health Resources published in Radiology Business Journal indicate that growth in medical imaging slowed, relative to US population growth, in this time period, and that CT utilization declined in most geographic regions—in some cases, by as much as 0.38%.
This slowing and/or decline in growth has, inevitably, become a factor in valuations of outpatient imaging centers. Many hospitals have attributed the change in volume to internal, structural factors, particularly the use of radiology benefit managers (RBMs).
Payors are increasingly employing RBMs to curb inappropriate imaging utilization, with an eye toward lowering costs. With this in mind, many hospitals have arrived at the conclusion that imaging growth will continue to soften; outpatient imaging center valuations, which are based partially on estimated future business growth, are trending downward, as a result.
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Engineering to Meet Patients’ Needs: A Conversation With Stephen Neushul, iCRco CEO
By Cat Vasko
 With reimbursement increasingly linked to patient satisfaction, as well as a growing consumer influence in health-care spending, making a positive patient experience possible is a priority for radiology groups and hospitals. Stephen Neushul, CEO of iCRco, a developer of CR, DR, and mammography systems (as well as complementary software), sat down with ImagingBiz.com to discuss how engineering, workflow, ergonomics, and dose-reduction capabilities intersect to improve the patient experience in imaging’s oldest modality.
ImagingBiz: Radiography is the oldest imaging modality and the one that touches the most patients. How do you envision it continuing to evolve?
Neushul: Radiographic technology had very primitive beginnings. In the beginning, it took a very long time to expose a film to get a very low-resolution exposure (something like 50 DPI), and you’d burn the patient in the process. Today, our systems can achieve 500 DPI, about 10 line pairs per millimeter, so we’ve already gone from very low image quality to high-resolution radiography.
As time goes by, our sensors are going to keep getting better, our machines are going to get more precise, and we’ll see more information within radiographic images. We saw that evolution when we went from film to digital imaging—the digital form is more convenient, and now it’s even better than film at visualizing the data, so the modality is evolving, as we speak.
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Only Connect: Social Media and the Radiology Practice
By Maril Hazlett, PhD
This article is the first in a three-part series.
 Facebook, Twitter, LinkedIn, Pinterest, and Reddit: The list of social-media platforms grows longer every day. These technologies offer tools that facilitate interactive, reciprocal dialogues among people, groups, businesses, and institutions. Social-media users number in the billions worldwide. They come together to build relationships, share information, and join communities of interest.
It’s a connected world. Should a radiology practice plug into it? What’s the value of developing a social-media presence, and what are the possible risks? “Radiology practices should view using social media as an opportunity to make themselves stronger and more valuable as health-care partners,” according to health-care lawyer and social-media user Thomas Greeson, JD, a partner with Reed Smith LLP who is on Twitter as @tgreeson.
“Used correctly, social-media tools can enhance a practice’s reputation and brand with patients, referring physicians, and hospitals,” Greeson says. “If radiologists want to fight against the stereotype and become more to hospitals than faceless, nameless, replaceable people sitting in front of workstations in dark rooms, then they would do well to consider social media.”
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CMS Puts MPPR Imaging Cuts Back on the Table
To find budget savings that would help cover a 7% increase in payments to Family Medicine physicians and other Centers for Medicare and Medicaid Services (CMS) wants, several proposed ideas for cutting reimbursement are back in play in the 2013 Medicare Fee Schedule Proposed Rule posted on July 6. This includes the unpopular multiple procedural payment reduction (MPPR) of 25% on the professional component for CT, MR and ultrasound services — a proposal more than 250 members of the House have said they are against by signing on to the Diagnostic Imaging Services Access Protection Act (H.R. 3269).
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ACR Partners with NDSC on Computerized Decision Support
The goal of getting ACR evidence-based imaging appropriateness criteria into the hand of more ordering physicians as they make their clinical decisions is another step closer. On July 11, the ACR announced an exclusive agreement with the National Decision Support Company (NDSC) to offer appropriateness criteria in digitally consumable format for computerized ordering and electronic health record (EHR) systems. NDSC will provide the technical platform, support, and licensing of the criteria under the name ACR Select.
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CMS Announces 89 New ACOs
The Centers for Medicare & Medicaid Services announced 89 new Accountable Care Organizations (ACOs) that will join the Medicare Shared Savings Program. The 89 new ACOs will coordinate care for nearly 1.2 million beneficiaries in 40 states and Washington, D.C. This brings the total number of providers participating in the program to 154, serving over 2.4 million Medicare patients across the country. Five of the new ACOs applied for a version of the program that allows them to earn a higher share of savings by being held accountable for a share of the losses if costs increase.
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AUGUST
AHRA 2012 Annual Meeting and Exposition
Sponsored by the AHRA
August 12–15
Gaylord Palms
Orlando, Florida
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OCTOBER
2012 RBMA Fall Educational Conference
Sponsored by the RBMA
October 7–10
Sheraton Wild Horse Pass Resort
Chandler, Arizona
Register >>
Economics of Diagnostic Imaging 2012
Sponsored by ESI Educational Symposia
October 24–28
The Ritz-Carlton, Pentagon City
Arlington, Virginia
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