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The Big Picture
Father-and-son Radiology
By Curtis Kauffman-Pickelle
 I have written in this column and spoken around the country about the perfect storm that the radiology profession is experiencing these days, and at the time of this writing, the storm clouds continue to gather. A call, last week, from industry veteran and colleague Tim Stampp, MBA, of Medical Imaging Specialists, capped another tumultuous month of reimbursement headwinds. Stampp alerted us to the fact that it seems that the CMS practice-expense RVU reimbursement assault has not been sufficiently addressed, nor have radiology groups sufficiently prepared to fight yet another cut at the margins—one that CMS hopes will go unnoticed, or at least be taken
merely as a minor adjustment (nothing to see here, folks—keep moving along).
The CMS strategy on reimbursement, these days, seems to focus on smaller, moderate cuts that, added together, have a cumulative impact on the practice’s revenue and profitability in far more significant ways than might seem to be the case at first glance. It is death by a thousand paper cuts. We have a lot of work yet to do to tell the profession’s unique story and to have that story understood at the highest levels of the regulatory bureaucracy.
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Improving Imaging Quality: The Macroeconomic View
By Cat Vasko
 In April, Medscape released results from its annual physician survey¹ on salary, job satisfaction, and more; among the most controversial of these results was the revelation that only 54% of those surveyed said that they would choose medicine again as a career. Stephen Pomeranz, MD, founder and CEO of ProScan Imaging (Cincinnati, Ohio), connects this sentiment with the struggle physicians have to improve quality: both, he says, are cultural issues that health-care organizations need to address.
“When you hear people talk about being unhappy with medicine, that’s very distressing,” he notes. “You’re getting asked to heal another human being. He or she is trusting and depending on you, and it’s lifelong learning.”
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Enhancing Service to Referrers: Progressive Radiology Case Study
By Cat Vasko
 Progressive Radiology was facing a problem familiar to many radiology practices: Hospital IT policies were interfering with its ability to deliver images and reports to referrers. Dominic Mezzanotte is director of information systems at the practice, which has 10 locations in Maryland. “We struggled with some of our top referrers, who are part of a hospital that is very stringent and didn’t want us installing any applications. When you try to install an application on a large organization’s environment, you need it to sign off,” he says.
To get around the problem, Progressive Radiology had been sending reports by fax and email—and, in some cases, even by courier. “Some referrers don’t even have email addresses,” Mezzanotte notes. “They’re busy with patients, and we have some who prefer not to use email.”
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Four Ways Radiology Groups Can Use Data in Hospital Contracting
By Jana Landreth, CPA
 The very nature of many radiology groups’ governance structures—highly democratic, split among multiple partners, and with each partner’s vote given equal weight—creates an unfortunate tendency toward emotional decision making. As the inside joke goes, in a radiology practice, you call 99 votes versus one vote a tie. Decision making can easily be hampered by one or two dissenting perspectives, and too often, the squeaky wheel gets the grease; the most emotional perspective carries the day.
Having data is the key to removing emotion from the decision-making process, and nowhere is this more true than for hospital contracting. For many groups, contracts are about much more than dollars and cents; they are about relationships, and this invites emotion into evaluations that now—more than ever—should instead be focused on hard factors such as staffing, revenue, and productivity.
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CMS Relaxes Rules on Ordering and Documenting Imaging Services
By Thomas W. Greeson, JD, Esq and Paul Pitts, JD, Esq
  Two years ago, CMS published an interim final rule¹ (with a comment period) implementing several changes to the Medicare and Medicaid programs mandated by the Patient Protection and Affordable Care Act. The interim final rule of May 2010 established new rules on obtaining and maintaining written orders for imaging services, as well as orders or referrals for durable medical equipment, home health care, and laboratory services. The interim final
rule required the legal name and national provider identifier (NPI) of the ordering physician or practitioner on the claim. In addition, the ordering and furnishing providers were each required to maintain documentation of the written order for seven years.
The ACR®, the RBMA, and other radiology organizations jointly submitted comments to CMS regarding specific aspects of the interim final rule. Now, CMS has signaled its acceptance of several major changes requested by the radiology organizations. In a final rule2 published April 27, 2012, CMS has revised the ordering and documentation requirements for imaging services in several ways that are favorable to the radiology community.
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MRI’s Pepsi Challenge: Comparing Boreless and Wide-bore Technologies
By Matt Skoufalos
 Lingering doubts about the image quality generated by open-bore MRI technology have, perhaps, unfairly held up its adoption. When a pair of radiology organizations set up the equivalent of an MRI Pepsi® challenge in their respective practice environments, staff members at both locations were surprised at the response.
 When Huntsville Memorial Hospital (HMH) in Texas was in the process of deciding on a new MRI system, the facility had narrowed its choices down to the Oasis boreless system from Hitachi Medical Systems and two wide-bore systems from competing vendors. Mike Scheidecker, RT(R), MRI/CT director at HMH’s outpatient imaging center, recalls that HMH flew its radiology director, Jason Loftin, to vendor sites from all three companies, and he was scanned (using the same sequences) at each site.
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Radiology Acquisitions and Change Management: RadNet’s Approach
By Greg Thompson
 Change is rarely easy, but Mark Stolper, executive vice president and CFO of RadNet, Inc (Los Angeles, California), says that it does not have to be painful. Communicating a workable vision and working with existing stakeholders can make all the difference because an acquisition has many moving parts. With 233 imaging centers now operating under the RadNet banner, Stolper knows this better than many: RadNet is the largest radiology group in the United States, with strong presences in California, Maryland, Delaware, New York’s Rochester and Rockland counties, Rhode Island, and Northern New Jersey.
Sticking almost exclusively to the East and West Coast markets has made RadNet and its regional practices familiar names in these populous regions. Private payors know the RadNet name because it carries considerable negotiating power, Stolper says; patients and referring physicians now RadNet’s centers and radiologist partners, as many of them have been fixtures in their medical communities for decades.
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Health Care Reform Will Not Mean Less Imaging: Regents Health
Whatever form the Patient Protection and Affordable Care Act (PPACA) may take—and we are, of course, in an election year—a confluence of factors conspires to keep radiologists in demand for the foreseeable future, says Brian Baker, President of the Franklin, TN-based Regents Health Resources. “There will be plenty of work if you want it,” Baker says. “We’re going to need the leadership and involvement of the radiologist community to help us define how to accommodate patient access to health reform volume.”
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Research Traces Causes of Unnecessary Imaging
Instances in which imaging is unnecessarily performed may be related to a gap in adherence to report recommendations, says new research from Harvard Medical School teaching affiliate, Brigham and Women’s Hospital. Repeat analysis of some 250 PET/CT patient reports gathered by researchers in the radiology department at the hospital showed that in 84 instances where imaging specialists recommended additional studies, these recommendations were unnecessary nearly half the time. Furthermore, referring physicians did not go ahead with recommendations for additional imaging nearly 70 percent of the time.
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FDA Issues Guidance Document on Pediatric Imaging
Today the FDA released for public comment a guidance document on pediatric imaging that should help x-ray manufacturers develop devices better suited to safely imaging child patients. Citing the increased radiosensitivity of children as compared with that of adults, the greater timeline along which overexposure could manifest as cancer, and the potential for children to be exposed to excessive radiation when using machines calibrated principally for adults, the regulatory agency is seeking the addition of pediatric settings, labeling, displays, and software to all new equipment.
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Most Stroke Victims Do Not Get Diagnostic Imaging Fast Enough
Fewer than half of all stroke patients undergo brain imaging within the AHA-recommended 25-minute window after arriving at the ER, according to a new study in the journal Stroke. CT or MR scans are critical in determining whether a stroke is caused by a blockage or a ruptured blood vessel, which dictates the course of treatment. The study is based on data collected from the AHA “Get with the Guidelines” program, which spanned some 1200 hospitals and 40,000 patients at the time it was collected. It found that only 41.7 percent of the patients with symptoms of stroke received brain imaging within 25 minutes of arrival at the hospital.
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MAY
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
Register >>
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