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The Big Picture
Where Have All the Profits Gone?
By Curtis Kauffman-Pickelle
 While I have used this space to discuss the impact of consolidation on the business of medical imaging, another indicator that the marketplace is maturing is the methodical erosion of profit margins in virtually every segment of the distribution of goods and services. I take that back: The insurance-company payors do not seem to be sharing as much pain as the providers, suppliers, and service organizations that support imaging, but that is a column for another day.
Fact: It is a basic tenet of our economy that profits are the lifeblood sustaining viability and growth (while providing for continuing investment in innovation). Although the concept of profit has been vilified by those who really do not understand its necessity as a critical element in this most basic law of economics, anyone who has tried to build a practice or hospital without profits has discovered—the hard way—that one cannot provide high-quality services unless there are the margins available to fund them.
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Restructuring the Radiology Practice: A Guide
By David Myrice
 There are multiple factors that might lead a radiology group to consider restructuring, but the majority of changes to a group’s governance are prompted by breakdowns in communication. This issue becomes particularly prevalent as groups expand; a single-site, hospital-based group of radiologists is able to handle critical decision making in a relatively casual manner, but a multisite group with a great number of partners will begin to experience potential internal dissent caused by poor communication.
This decentralization, nearly inevitable as practices grow, can have disastrous consequences. A hospital that is not satisfied with its radiology service, for instance, will expect a swift response from the group—the kind of response that cannot be coordinated without a more unified approach to decision making. Restructuring, however, is not without its hazards, and groups undergoing the process should be aware of best practices for ensuring that any new governance structure is effective from day one.
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Integrated Delivery Systems: One Size Won’t Fit All
By Cat Vasko
 On April 1, 2011, the DHHS released its proposed new rules for accountable-care organizations (ACOs), putting in motion provisions of the health-reform package aimed at improving patient care through better coordination among providers. With the ACO program set to launch in January 2012—following a period during which stakeholders can comment on (and the DHHS can adjust) the proposed rules—physician alignment is a buzzword for both hospitals and medical groups. Providers, though, will probably find that when it comes to greater integration, one size does not fit all, according to Nick Fabrizio, PhD, a consultant for the Medical Group Management Association.
In “Integrated Delivery Systems: Forming, Storming, and Performing,” which he presented in Chicago, Illinois, on March 23, 2011, at the Congress on Healthcare Leadership of the American College of Healthcare Executives in Chicago, Illinois, Fabrizio shares both the hospital and the private-practice perspectives on health care’s upcoming sea change. Referring to the recent trend toward greater physician alignment as the great migration, Fabrizio points out, “There are tremendous challenges on physicians in private practice today” that might give them incentives to seek the security of some form of integrated delivery system.
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Imaging on the Move: Q & A with RadNet CFO Mark Stolper
By Rich Smith
 As the trend of consolidation among imaging centers continues, RadNet, Inc (Los Angeles, California) is at the leading edge, having added 24 freestanding outpatient centers in 2010 alone. The company, founded in 1984, today owns and/or operates a network of more than 200 quality-oriented, cost-effective facilities, and it is poised to continue increasing that number. Mark Stolper, executive vice president and CFO of RadNet, spoke with ImagingBiz about the company’s present and future ambitions.
ImagingBiz: With all the uncertainty that exists in health care today, why is RadNet so confident about the future of outpatient imaging centers?
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What Emergency Physicians Want From Radiology
By Cat Vasko
 Results of a study¹ released in Chicago, Illinois, during the 2010 annual conference of the RSNA confirm what many in both the radiology and emergency-medicine communities already knew: Utilization of imaging in the emergency department has exploded. According to the Radiology study,¹ emergency-department visits that included CT imaging increased from 2.7 million in 1995 to 16.2 million in 2007, with no signs of a tapering off in growth.
A similar Archives of Internal Medicine
study² shows growing use of both CT and MRI as tools for evaluating potential neurological conditions; it concludes that the greatest imaging increase in emergency departments since 1997 has been in head CT and MRI. Fresh research³ from the 2011 annual conference of the American College of Cardiology (held in New Orleans, Louisiana) confirms CT angiography’s effectiveness in triage for patients with acute chest pain.
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Developing a Data-storage Strategy
By George Wiley
 Cloud-based storage requires evaluation, just as any other storage strategy does, according to James T. Whitfill, MD, CIO of Scottsdale Medical Imaging Ltd (SMIL) in Arizona. “You have to understand how the cloud provider replicates data to different locations, so you trust that there really are multiple copies of those data; that they are kept secure, from a physical perspective; that there are environmental controls, and that your data are not being accessed,” he observes. “Under HIPAA, you must protect that access.”
He asks, “How does that cloud provider guarantee that when you delete those data, if you want to, they are really gone? You think that those data have been destroyed, but can that cloud provider guarantee that they were destroyed?”
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Obama, GOP Butt Heads Over Future Of Medicare
President Barack Obama yesterday outlined his plan for reducing the federal deficit and cutting Medicare costs, noting that unlike the GOP plan, his would “use a scalpel, not the machete.”
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MedPAC Recommends Prior Authorization For Advanced Imaging
The Medicare Payment Advisory Commission (MedPAC) on April 7 passed a recommendation that Medicare require clinicians who order more imaging studies than their peers obtain prior authorization for advanced imaging.
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Inspection Uncovers Over-Radiation Of Infants
In the latest incidence of patient over-radiation reported by the media in recent months, the New York Times today reports a discovery by state health inspectors of nearly two dozen cases in which preterm babies received “improper” X-rays at a Brooklyn, New York hospital. The findings came to light only a few months after an initial report revealed that the institution—State University of New York Downstate Medical Center—had similar problems in 2007, according to the newspaper.
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ACR Releases New Appropriateness Criteria
New evidence-based guidelines to help health care providers choose the most appropriate medical imaging exam for a patient’s clinical condition are now available via the latest version of the American College of Radiology (ACR) Appropriateness Criteria®.
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JUNE
SIIM 2011
Sponsored by the Society for Imaging Informatics in Medicine
June 2–5
Gaylord National Resort and Convention Center National Harbor, Maryland
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2011 Radiology Summit
Sponsored by the RBMA
June 5–8
Hilton New Orleans Riverside New Orleans, Louisiana
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International Symposium on Multidetector Row CT
Sponsored by the International Society for Computed Tomography
June 13–16
Hyatt Regency San Francisco, California
Register >>
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