THE BIG PICTURE

What Imaging Leaders Should Know About Teamwork
By Curtis Kauffman-Pickelle

The following is not a trick question: What does the US Army’s legendary 82nd Airborne Division have in common with today’s medical-imaging profession? On the surface, probably not a lot; beneath the surface, however, I’ve seen quite a bit that our profession can learn from the focus, precision, and ethos of one of the finest US organizations. This is especially true when one considers that in order to accomplish its national-security mission, this group requires supremely refined teamwork for even the most minute of its tasks.

First, the backstory: I am fortunate enough to belong to an organization of like-minded executives who share the honor of visiting selected US Department of Defense facilities, inside and outside the country, for the purpose of understanding their respective missions, as they apply to today’s national-security interests. It’s pretty amazing, and it’s eye-opening on many levels. On a recent trip, we visited Fort Bragg, North Carolina, and spent some up-close-and-personal time with the 82nd Airborne, even flying in a C-130 with paratroopers to witness, at first hand, how they do what they do.

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Meaningful Use: Safety and Quality of Care
By Cat Vasko

For nearly a year and a half following the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the medical community had one question on its mind: What constitutes meaningful use? The HITECH legislation stresses that in order to receive stimulus funding for health IT, providers must prove meaningful use of that technology.

On July 13, 2010, meaningful use was defined—or, rather, the stage 1 requirements for achieving it were spelled out, almost 17 months after the HITECH Act’s enactment. On August 4, Jonathan Teich, MD, PhD, CMIO of Elsevier Health Sciences, led a webinar sponsored by the Healthcare Information and Management Systems Society (HIMSS), parsing meaningful-use requirements as they relate to the stated DHHS goal of improving the safety and quality of care.

“It’s striking a balance between the overall goal, using EHRs to improve quality, while encouraging widespread adoption and avoiding an excessive work burden on physicians. While not fulfilling every quality metric that the policy committee would like, you’re gaining the capability to do that.”

—Jonathan Teich, MD, PhD, CMIO of Elsevier Health Sciences

Teich began with a brief historical overview of the meaningful-use concept. A proposed rule released in January of this year garnered over 2,000 comments, Teich notes, some in support of the rule and most requesting changes. “If I had to summarize the most common comments, number one was the concern that this was an all-or-nothing proposition,” Teich says. “There was a general sense of inflexibility. Because practices are so different, it was difficult to understand how a variety of them would pass this.”

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Why Hospitals Buy Imaging Centers
By C. Elliott Jeter, CFA, CPA/ABV, and Todd Sorensen,

While hospitals have always been significant players in the market for freestanding imaging centers, volume for hospitals purchasing all or part of the ownership interest in freestanding imaging centers has increased dramatically over the past few years. For hospitals already involved in joint ventures with physicians or entrepreneurial companies, we have seen a flurry of transaction activity around hospitals buying out their joint-venture partners.

In many cases, hospitals desire to maintain consistent subspecialized professional coverage across all inpatient and outpatient radiology. This is not only beneficial from a quality standpoint, but also may allow the hospital strategically to expand opportunities for the radiologists with whom it maintains exclusive arrangements

While the benefits of a transaction are mutual, discussions are most often initiated by the freestanding imaging center’s owners, consisting of radiologists, referring physicians, and even entrepreneurs. The effects of reimbursement cuts; increasing regulatory restrictions on the operation of referral-source imaging; lack of access to credit; the hassle of running a small business; and large, pending capital requirements for equipment have driven many freestanding imaging centers’ owners from a position of strength to one of weakness, relative to hospitals.

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When Your Quality Is Questioned: Answers From Frank Seidelmann, DO
By Cat Vasko

Recent media coverage of a radiologist’s accusations of inaccuracy against Radisphere National Radiology Group, Cleveland, Ohio, returns the question of quality to the forefront of discussion in the radiology community. ImagingBiz spoke with Frank Seidelmann, DO, chief innovation officer and clinical director of neuroradiology for Radisphere, both about the accusations and about how quality can be quantified, defended, and improved across the profession.

ImagingBiz: Accusations were leveled against Radisphere by a locum tenens radiologist you contracted with at a California hospital. What is your response?

Seidelmann: I think this is best described by the phrase, bad news travels fast, good news doesn’t travel at all. We take quality assurance (QA) and peer review very seriously; we’re one of the few organizations that has a full time QA/peer-review staff. As radiologists, we undertake daily double-blinded reviews, which most radiology groups don’t do. It’s extremely time consuming, but we take it very seriously.

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Radiology and the MPFS: Implications and Impact
By Jane Cys

CMS released the 2011 Medicare Physician Fee Schedule (MPFS) in July, proposing myriad changes that CMS notes would result in a 6% payment cut for radiology services. That reduction doesn’t include the impact of the 23% cut that will take place on December 1, when this year’s temporary 2.2% payment update expires—or the additional 6.1% cut resulting from the 2011 sustainable growth rate (SGR) calculations, according to CMS. The 2011 proposal also begins implementing provisions of the Patient Protection and Affordable Care Act.

Pam Kassing, MPA, RPC, senior director for economics and health policy at the ACR®, notes that the total Medicare monies allocated to physician services will shrink by $3 billion, and spending will also be redistributed among specialties. Radiology took the biggest hit, Kassing adds. “We were at the epicenter of an earthquake, and everybody else felt a little shake,” she says.

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Image Storage and Sharing as a Service: A DOCHS Case Study
By Cat Vasko

Six-hospital Daughters of Charity Health System (DOCHS), Los Altos Hills, California, was facing a problem increasingly familiar to providers of imaging services (and particularly to multihospital networks): It was becoming too expensive and difficult to manage its long-term image archive. All archived images were stored in hospital-managed data centers, making them both costly to keep and tough to access. The health system responded by purchasing more tier-one storage, but it was a temporary fix for a growing problem.

David Siva, director of medical information systems and technology at DOCHS, says, “Our initial strategy was to grow and manage our storage locally as we leveraged the utilization of our technologies for our variety of PACS, but we found that we were growing at a much greater rate. We found that we had a significant amount of storage that was either unused or not used as well as it could have been—and we needed a better long-term and off-site archive strategy, as well, for disaster recovery.”

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Adjusting Focus: Patient-centered Radiology
By Kris Kyes

Having cold water dashed in one’s face can result in spluttering, but it can be welcome when an effective wake-up call is needed. Both reactions to a 2010 article¹ on patient-centered radiology might be expected; the authors deliver a sometimes-harsh assessment of radiology’s shortcomings, but they also offer concrete suggestions that could help protect the specialty from commoditization, reduced reimbursement, and an uncertain future.

Stephen J. Swensen, MD, MMM, and C. Daniel Johnson, MD, MMM, are Mayo Clinic radiologists and professors of radiology based in Rochester, Minnesota, and Scottsdale, Arizona, respectively. Their premise is that radiology is a target that cannot survive the forces converging on it unless it can become patient centered. Radiology must respond to patients’ wishes in everything that it delivers, and it must amass the data needed to prove that it does exactly that.

Radiology must grant the five primary wishes of patients: for enough information to make decisions, for the correct exams to be ordered, for those exams to be performed safely, for sound interpretations to be communicated effectively, and for the prices charged to be fair, according to Swensen and Johnson.

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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

Strategies for MDCT Dose Optimization
An article in the most recent issue of the Journal of the American College of Radiology: JACR looks at the implementation of a multidetector CT dose-optimization strategy based on a methodology of auditing, feedback, didactic training, and re-auditing. The Australia-based study concludes that this method “could achieve clinically important dose reductions in volunteer practices.”

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Employment Grows in Ambulatory Care
The health-care sector gained 26,600 jobs in July, representing 0.2% growth. Physicians’ offices added 1,100 jobs (0.1% growth), while hospitals lost 2,300 jobs (0.1%). Most of the growth was seen in ambulatory services, especially home health services; ambulatory care in general added 23,100 jobs, and home health services have grown 4.8% in the past year.

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HOPPS Final Rule Clarifies Physician Supervision
In the 2011 Hospital Outpatient Prospective Payment System final rule, CMS provides clarification of the term direct supervision. For on-campus services, direct supervision means that the supervising physician or nonphysician needs to be present on campus and available immediately to provide assistance; the same rule applies to services provided in off-campus, remote locations. CMS notes that Medicare does not make a payment to a physician when the physician is providing direct supervision of hospital outpatient procedures, but does not furnish a direct professional service to a patient.

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Better Ergonomics for Radiology?
An article in the August issue of RSNA News looks at research from Massachusetts General Hospital, Boston, indicating that job-related musculoskeletal symptoms are common among radiologists working in digital departments. In a questionnaire completed by 28 radiologists, 42.8% reported neck pain, 39.2% reported back pain, and 32.1% reported shoulder pain and/or headaches. The study’s lead author concludes that subsequent investigation of workplace ergonomics in radiology is warranted.

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AUGUST

AHRA 2010 Annual Meeting and Exposition
Sponsored by AHRA: The Association for Medical Imaging Management

August 22–26
Gaylord National Resort and Convention Center Washington, DC

The Association for Medical Imaging Management's Annual Meeting will feature over 1,000 leaders in the imaging field, with dozens of sessions addressing management issues ranging from finance to operations.

[Register]

SEPTEMBER

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

September 21, 2 PM Eastern
Save the date.

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

September 23, 2 PM Eastern
Save the date.

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]

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.

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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.

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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.

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