THE BIG PICTURE

A Hospital C-suite Reality Check
By Curtis Kauffman-Pickelle

A few converging issues have recently revealed a fissure in the otherwise strengthening position of hospitals and health systems in the competition for outpatient-imaging supremacy. I have written volumes about the importance of building a two-way, give-and-take model in hospital–radiology group relationships so that both parties can thrive. The emphasis has generally been placed on what radiologists need to do to understand both their vulnerability and the new requirements for treating the hospital partner as a customer: providing superior service and fully aligning with what is often their most significant revenue stream.

What, though, of the hospital C-suite executive? What is your responsibility in ensuring that you are delivering the highest levels of imaging quality at the most reasonable price, therefore fulfilling your mandate to maintain and support the best and most efficient radiology group? Yes, tensions exist in many areas of the country between hospitals and aggressive, tone-deaf radiology groups that suddenly find themselves in adversarial relationships with their hospital partners.

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Community Hospital Makes Strategic Post-reform Decision
By Cheryl Proval

In the aftermath of health care reform, organizations continue to strategize on how best to succeed in such an uncertain environment. Although significant questions still remain, two factors are certain—health care organizations will see less reimbursement, but will experience greater demand for services. With these two forces at play in the marketplace, organizations are looking at how to do more with less, and are making purchasing decisions that position them to be able to accommodate the widest range of patients. That’s why Brian Wetzel, RT, CNMT, radiology administrator at 267-bed Lourdes Hospital in Binghamton, New York, chose an MRI system that could effectively image any patient, especially extra-large patients.

Founded by the Daughters of Charity, Lourdes Hospital is an Ascension Health hospital that offers a full range of services, including a 15-practice primary-care network, a diabetic center, wound care and hyperbaric-oxygen therapy, women’s and pediatric health care, a regional cancer center, and orthopedics and rehabilitation.

The hospital referred an average of six claustrophobic, pediatric, and bariatric patients a week to neighboring hospitals due to weight restrictions and a lack of open technology. A single, closed 1.5T magnet represented the hospital’s MRI capacity, according to Wetzel, administrative director of diagnostic imaging, cardiology, and the vascular laboratory. He presented “Know Your Market to Grow Your Market,” on August 24, at the annual meeting of AHRA: The Association for Medical Imaging Management, in Washington, DC.

“We averaged five claustrophobic patients per month, most unaware that they were claustrophobic when they first came in; we averaged six patients per month who were exceeding weight restrictions identified within screening upon arrival. Approximately six patients per week were referred to another facility due to weight and other restrictions. We were sending away patients.”

—Brian Wetzel, RT, CNMT, administrative director, Lourdes Hospital, Binghamton, New York

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Users’ Guide: Due Diligence for Acquisitions
By Perry Baker, CPA

While there are many motivations to pursue an acquisition candidate, all acquirers share a common goal: increasing their net worth. The buyer evaluates opportunities to select acquisitions where the present value of the future economic benefits received is most likely to be greater than the purchase price. The goal of the due-diligence process is both to confirm the purchase price and to determine the future economic benefits of the acquisition.

The first goal of the financial due-diligence process is to validate the historical earnings of the business to be acquired. The first reason to confirm historical earnings is to validate the purchase price. While some valuations are based on the fair market value of the assets, the replacement value of the operations, or the liquidation, many valuations are based on the historical financial performance of the imaging center, either as a multiple of earnings or as the present value of the future cash flows.

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Business 101: Goal Execution for Radiology
By Cat Vasko

This article is the third 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.

Executing strategic goals represents a challenge for any organization, in terms of both maintaining momentum and creating a sense of accountability among staff. For radiology groups, add another obstacle to that list: balancing the achievement of overarching goals against increasingly hectic day-to-day routines in which maximizing efficiency is critical to survival. Greg Thomson, executive vice president, Medical Management Professionals Inc (MMP), Atlanta, Georgia, advises, “The execution of goals has to be part of daily operations. It has to be a scheduled part of your calendar—at least monthly, if not biweekly.”

Thomson and Dan Simile Jr, MMP’s executive vice president of practice management, recommend that radiology organizations establish a set of annual wildly important goals (WIGs) that are consistently reinforced through meetings, scoreboarding, and feedback. Executing WIGs requires self-discipline, they stress, as well as commitment and enthusiasm from leaders. “So many companies and practices get involved in activities that are not moving them toward their goals,” Thomson says. “All members of the organization need to be accountable to one another.”

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Radiology Lobby: Advocacy for High Stakes on Capitol Hill
By George Wiley

Not every lobbying effort on the part of the imaging industry is a success. When the DRA was passed, for example, radiology took a hit; reimbursements were pared, and the industry emerged feeling that its rapid growth had left it with a target on its back.

Cindy Moran, who now directs what she calls “a totally full-service deep advocacy program” for the ACR®, recalls, “The pressure was extraordinary to cut, and because diagnostic imaging was vulnerable, we were reduced significantly.”

Moran says that the passage of the DRA, which came at 3 am on a Friday near Christmas, taught a lesson to the ACR and to the diagnostic-imaging industry in general: prepare better and lobby harder. “At 3 am, the ability to stop that bill was next to zero, so you spend a lot of time trying to understand and react,” she says.

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Imaging’s 21st-century Challenges: Decentralization, Digitization, and Distribution
By Cat Vasko

In many ways, the challenges facing imaging in the 21st century are similar to those facing other industries: decentralizing both staff and workplaces; digitizing data; and distributing those data in a way that is efficient, cost effective, and secure. Anthony Toppins, MD, musculoskeletal radiologist with American Radiology Associates, Dallas, Texas, brought the imaging perspective to bear on these issues while consulting on the development of a new image-sharing solution, Health Image Share.

Image Share is a service included in the Symantec Health offering from data-security firm Symantec Inc (Mountain View, California). It provides long-term, on-demand storage for those struggling with the soaring cost of medical-image archiving.

“We now use the Internet to pay our bills, order our prescriptions, interact socially, and conduct our various work-related activities,” Toppins says. “It is an integral part of our lives, well beyond email and Web surfing. Medicine and medical imaging, in particular, are natural extensions of this technology.”

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Better Breast-imaging Workflow: UCSF Case Study
By Erin Burke

When the women’s imaging department at the Mount Zion campus of the University of California–San Francisco (UCSF) began transitioning to full-field digital mammography, workstations were implemented to enable radiologists to manage the digital workflow. The very technology that was intended to harness the potential of digital imaging, however, proved to be limiting on many levels.

Not only were the workstations unable to display breast ultrasound and MRI, but radiologists could only view one set of prior studies at a time, according to Bonnie Joe, MD, PhD, chief of women’s imaging. Another problem was the workstations’ inability to communicate with the department’s RIS; to compensate, technologists in the department were required to create paper-based worklists and print out copies of patient reports every day. The process was time consuming, and it increased the chances of radiologists missing a patient, as well as creating difficulties in determining which radiologist had read which scan. “The process slowed down patient care, and we were limited by how quickly we could print out a piece of paper,” Joe says.

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Regulatory Update: September 2010
By Jane Cys

CMS plans to implement a two-year Medicare Imaging Demonstration Project that will test whether decision-support systems can promote the appropriate ordering of imaging services using criteria established in current medical-specialty guidelines. The project will focus on MRI, CT, and nuclear-medicine diagnostic-imaging services. The 11 targeted services chosen within these modalities—CT of the brain, sinuses, thorax, abdomen, lumbar spine, and pelvis; MRI of the brain, lumbar spine, shoulder, and knee; and nuclear imaging of the heart—have high expenditures and utilization among Medicare fee-for-service beneficiaries.

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Restructuring to Improve the Customer Experience
By Cat Vasko

Growing business while staying ahead of the competition is a focal point for most organizations, particularly in the competitive and high-stakes health care market.  Maintaining and striving to further enhance the delivery of high customer satisfaction are also vital to long-term success.  In August, FUJIFILM Medical Systems USA, Inc., Stamford, Conn, decided to reorganize to better meet those two ends.  Explains Robert Cooke, senior vice president, “Like all organizations, we face the continued imperative for growth, and that requires regular evaluation of our strategies and associated structure. We realigned to improve the overall experience that customers have with our company and our technologies, and our goal is to maintain that high level of satisfaction as we continue to expand our portfolio and further integrate our solutions offering.”

The primary function of the reorganization was establishing cross-functional ties throughout the organization, enabling more effective collaboration among all departments and at all levels of the company.  To that end, under the new infrastructure, Cooke, who previously led the Medical Informatics Division, will now fulfill the expanded role of overseeing both sales and marketing of solutions delivery and support, as well as sales and marketing operations for all products and distribution channels.  His and other key leadership positions have been restructured to straddle customer service and product development

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PUBLISHER
Curtis Kauffman-Pickelle

EDITORIAL DIRECTOR
Cheryl Proval

EDITOR
Cat Vasko

ADVERTISING DIRECTOR
Sharon Fitzgerald

PRODUCTION COORDINATOR
Jean Lavich

TECHNICAL EDITOR
Kris Kyes

WEB MASTER
Robert Elmquist

CONTRIBUTING WRITERS
Jane Cys

HHS to Award $17 Million for Outcomes Research
On September 1, Kathleen Sebelius, HHS secretary, announced that the government will distribute $17 million for patient-centered outcomes research, using funds made available under the American Recovery and Reinvestment Act. Five cooperative-agreement awards will go to organizations in four states to create the Community Health Applied Research Network, while two grants, of $3.5 million each, were awarded to Columbia University and the American Academy of Pediatrics.

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Long Workdays Affect Radiologist Accuracy
A study in the September issue of the Journal of the American College of Radiology: JACR measures radiologists’ diagnostic accuracy after a long workday. Forty attending radiologists and radiology residents viewed 60 bone examinations (half with fractures) before and after a day of clinical reading; researchers recorded reading time, visual accommodation, and subjective ratings of symptoms of fatigue and eyestrain. The study’s disturbing findings indicate that diagnostic accuracy is reduced significantly after a day of clinical reading.

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ACR Seeks Volunteers for Performance-measure Testing
The ACR® is developing a project to test radiology-specific performance measures, some of which are included in the Physician Quality Reporting Initiative (PQRI), and is seeking volunteers to share specific information about their practices and patients. The ACR is planning to test radiology measures related to stroke and neurological imaging, use of fluoroscopy, mammography, and nuclear-medicine bone studies, and practices can participate regardless of whether they participate in PQRI. Information gathered from this project will be used to refine the testing measures.

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Medical Groups Oppose Litigation-deduction Proposal
Led by the AMA, 90 medical groups have sent a letter to the US Treasury Department stating their opposition to a proposed policy that would allow trial lawyers to deduct litigation expenses from their taxes. According to an AMA statement, the policy would cost taxpayers $1.5 billion and would further inflate the cost of health care. The AMA says that instead, it supports medical-liability reforms such as those enacted in California and Texas, where noneconomic damages are capped at $250,000.

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CPOE Could Reduce Inappropriate Scans
An article in the September issue of RSNA News covers recent research into the use of clinical decision support tools to reduce unnecessary imaging. Researchers at Massachusetts General Hospital in Boston compared computerized provider order entry (CPOE) with and without a hard-stop-on-red function, which requires on-call physicians to authorize certain advancing imaging exams, and found that CPOE with the hard-stop function resulted in 28% fewer exams being ordered by nonclinicians.

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SEPTEMBER

Webcast: Extreme RIS: Breaking Down Communications Barriers
Sponsored by FUJIFILM Medical Systems USA, Inc

September 21, 2 PM Eastern
Register

Webcast: Centralized Imaging and Collaboration in Today's Decentralized Imaging Business
Sponsored by Symantec

September 23, 2 PM Eastern
Register

2010 RBMA Fall Educational Conference
Sponsored by the RBMA

September 26–29
Renaissance Austin Hotel Austin, Texas

This year’s RBMA Fall Educational Conference will feature more focused education in track format and will include billing, legal, human-resources, imaging-center, interventional-radiology, and technology tracks.

[Register]

Follow ImagingBiz's coverage of this conference at our Stat Read blog:
StatRead

OCTOBER

2010 ASTRO Annual Meeting
Sponsored by the American Society for Radiation Oncology

October 31–November 4
San Diego Convention Center San Diego, California

ASTRO’s 2010 Annual Meeting will feature various educational symposia and CME activities for physicians, physicists, technologists, dosimetrists, and nurses. This year’s conference is ASTRO’s largest scientific program ever, with sessions on patient safety, quality improvement, efficacy, and the challenges of practicing medicine in the evidence-based era.

[Register]

Economics of Diagnostic Imaging 2010
Sponsored by ESI Educational Symposia

October 27–31
The Ritz-Carlton Pentagon City Arlington, Virginia

The 2010 EDI meeting will focus on strategies for success in the changing radiology market, focusing on issues that include utilization management, hospital negotiations, compliance and coding, pay for performance, and more.

[Register]

NOVEMBER

RSNA 2010
Sponsored by the RSNA

November 28–December 3
McCormick Place Convention Center Chicago, Illinois

With 4,200 scientific papers, posters, and educational exhibits; over 700 technical exhibitors; 300 refresher courses; and new special-interest and hot-topic sessions, the largest conference of medical imaging professionals in the word will offer relevant, cutting-edge science, education, and technology.

[Register]