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The Big Picture
Leadership As Performance Art
By Curtis Kauffman-Pickelle
 I am sure that many of you have read the great 2004 book by Fred Lee, If Disney Ran Your Hospital
¹. I have often used the material in this definitive treatise on customer service in my strategic-planning retreats, as the ideas and concepts about which Lee writes are timeless and apply to virtually any service organization. The book’s key takeaway is essentially that people judge organizations based on the total experience of their encounter with the enterprise. They compare this experience not necessarily with experiences at other, similar providers (in this particular example), but with what they know as the best customer-service experiences that they have had anywhere.
It’s not surprising that Disney always tops the list of organizations seen as the best of the best. While this might not have been much of a concern in times past, when consumer choice was not a significant part of the referral equation in health care, the emergence of consumer-directed health care (as well as increased competition in virtually every market) has made the building of brand loyalty among patient populations increasingly important to all providers—and especially to medical-imaging services.lick
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A Clearer View: Enriching Radiologist Workflow
By Cat Vasko
 
The next frontier in radiologist workflow won’t be another enhancement to hanging protocols, a faster processor, or an improved graphical user interface, Eliot Siegel, MD, and Woojin Kim, MD, predict. Instead, these two experts in radiology informatics are looking outside the PACS and its workstations to offer radiologists a clearer view of patients’ enriched clinical histories. Siegel, who is professor of diagnostic radiology and associate vice chair for informatics at the University of Maryland Medical Center (UMMC) in Baltimore, says, “We believe PACS will be significantly different in the near future from what it was in the first 20 years. We want a PACS where the workflow for the radiologist is much more tightly integrated with information from the electronic medical record (EMR).”
Kim, who is assistant professor of radiology and associate director of imaging informatics at the Hospital of the University of Pennsylvania in Philadelphia, points out that as the radiologist’s role has evolved, the amount of clinical feedback that he or she receives has decreased. “A lot of radiologists will look at an image and say it’s a carcinoma and needs a biopsy, but a lot of times they’d love to find out if it was a malignant tumor, in the end, and they never get that feedback,” he says.
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Improving Hospital-based Imaging Service
By Milan diPierro and Bob Oldfield
  The pressure is on for hospitals to improve their imaging customer service. CMS is poised to begin linking 1% of annual reimbursement to improvements in patient-satisfaction scores; meanwhile, it is imperative that hospitals aggressively grow profitable service lines like imaging to combat declining reimbursement and utilization.
Hospital-based imaging centers seeking to grow their outpatient volume by improving service, however, will encounter a unique set of obstacles not faced by their freestanding peers. Without engaging the referring-physician base, they will find themselves only reaching one segment of the community, leaving valuable market share on the table while failing to capitalize on huge investments in equipment. It is possible to overcome the traditional hospital mindset to provide outstanding outpatient care linked with a high level of customer service, but doing so requires a very different approach from that employed at freestanding imaging centers.
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Leveraging Imaging Technology to Enhance the Patient Experience: Tenet Healthcare
By Cat Vasko
In 2006, Tenet Healthcare Corp of Dallas, Texas, was operating 20 outpatient imaging centers across the country, and it was watching its outpatient imaging volume continue to slide. Dale Skrnich, senior director of outpatient services for the organization, explains that many of the imaging centers were being operated as hospital departments; “They offered a poor patient experience, no marketing or dedicated resources for sales, and no standardized imaging technology to speak of,” he says. Where similar organizations saw half their revenues coming from outpatient services, Tenet’s outpatient services only accounted for a third. “We wanted to decrease that delta,” Skrnich says.
In “Patient Centered Business Models in Diagnostic Imaging,” an exhibitor symposium given by three presenters in Dallas, on August 16, at the 2011 meeting of AHRA: The Association for Medical Imaging Management, Skrnich shared that between 2007 and 2011, Tenet expanded its outpatient imaging presence to 54 imaging centers, while increasing volume and revenue.
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Standards 2011–2012: What The Joint Commission Wants From Hospital Imaging Departments
By Julie Ritzer Ross
 The Joint Commission’s 2011–2012 standards will bring changes for hospital radiology departments, according to Judith M. Atkins, RN, MSN, president and CEO of McKenna Consulting in Charleston, West Virginia, and Robert A. Wise, MD, medical advisor to the Joint Commission’s Division of Healthcare Quality Evaluation. Atkins outlined some of these changes in “Joint Commission 2011–2012: Update for Hospital Imaging Department,” presented in Dallas, Texas, on August 15, 2011, during the annual meeting of AHRA: The Association For Medical Imaging Management; Wise provided comments later.
Changes in accreditation requirements and processes implemented in line with Joint Commission standards are not specific to radiology, Wise observes. They will affect hospital imaging departments in a variety of areas, however.
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New Payment Models and the Radiology Practice
By Cat Vasko
This article is third in a four-part series about health-care reform’s impact on radiology. To read the first article in the series, click here; to read the second, click here. 
 In the short term, radiology practices might have less to fear from the accountable-care organization (ACO) than from a similar term: the acute-care episode (ACE). That is the contention of Ed Gaines, JD, chief compliance officer for Medical Management Professionals Inc (MMP), Atlanta, Georgia. “CMS is now posting savings from the ACE demonstration project, and that is a stark difference from what we are seeing with ACOs,” he says. “In my opinion, although the ACOs have gotten a lot more press and attention, these bundled-payment demonstrations are potentially more threatening to radiology.”
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Developing an Imaging Strategic Plan: Intermountain Healthcare
By Greg Thompson
 Exactly what portion of the hospital bottom line comes from imaging? It’s a straightforward question, but even hospital executives occasionally grope for an answer.
The difficulty often stems from an inability to see the proverbial forest for the trees. As a 26-year imaging-industry veteran, Brian Baker, president of Regents Health Resources (a consulting and development company based in Franklin, Tennessee), has seen the lack of big-picture strategy all too often. It starts from the top, filters down to the director level, and ultimately inhibits the coveted goal of system-wide integration.
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Evolution of a Technology: Long-bone Imaging
By Cat Vasko
When Leo Reina, president and CEO of Reina Imaging (Chicago, Illinois), a radiography repair and manufacturing company, first entered the business 32 years ago, long-bone imaging was still largely the purview of chiropractors and orthopedists. “Chiropractors would do it looking for curvature of the spine,” he recalls, “and as prosthetics became more common, more orthopedists started doing it for either the full spine or hip-to-ankle imaging.” As time went on, the technology was widely accepted as a means of diagnosing scoliosis, and it soon became part of radiologists’ armamentarium as well. “The current issue is the transition from film to digital operation,” Reina says. “We’re working to resolve imaging problems specific to those long studies, which require specialized equipment and training.”
While radiography in general has progressed naturally from analog imaging to CR to DR, Reina notes that long-bone imaging presents special challenges. “In long-bone imaging, the anatomy tends to be thick at one point and thin at another, so taking one single image to encompass all anatomy regions is a problem in terms of continuity,” Reina says, “and DR has not historically had any receptors large enough to encompass the entire anatomy.”
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Increased CT Scans in ER Linked to Decreased Admissions
While the volume of CT scans administered in emergency rooms has increased dramatically in recent years, a new study published in the Annals of Emergency Medicine links such an increase to fewer hospital admissions. According to the study, the use of CT scans in emergency departments rose by 330% between 1996 and 2007. Authors of the study deem the resulting reduction in hospitalizations beneficial to patients and the healthcare system alike. In 1996, the study shows, the rate of hospitalization following CT scan was 26%. That rate had, by the conclusion of the study period in 2007, declined by more than half, to 12.1%. Researchers identified a similar pattern of declining risk of admission or transfer to intensive care units during the period.
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ACR to ‘Supercommittee’: No Imaging Cuts in Upcoming Proposals
The American College of Radiology (ACR) recently sent a statement to newly appointed members of the Joint Select Committee on Deficit Reduction, urging that cuts to diagnostic imaging services not be included in any upcoming legislative proposal. Within the statement, the ACR notes that reimbursement for and spending on advanced medical imaging services, including MRI and CT scans, has been dramatically reduced. The statement also includes the society’s position that cumulative effect of the” assault” on diagnostic imaging reimbursement through the legislative and regulatory process, which began in 2005, is hampering the growth of the specialty of radiology and patient access to important, life-saving medical services.
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Health Care Landscape On the Mend, Berwick Says
Improvements to the health care landscape are beginning to crop up, despite pressure on the Centers For Medicare and Medicaid Services to slash funding for Medicare and other health care programs in response to poor economic conditions. Speaking at a briefing in early September, CMS Administrator Donald Berwick, MD, said CMS believes that improving health care will decrease costs and make it more sustainable, likening the strategy to that followed by almost every other industrial sector. For example, he says, prices on desktop and laptop computers have decreased as manufacturers have enhanced their functionality. “It is within our grasp,” Berwick states. “You can see piece by piece, case by case, examples of that playing out.”
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California Passes ‘Dense Breast Tissue Notification’ Bill
A bill that requires health care providers to inform women when they are found to have dense breast tissue has been passed by the California State Legislature, reports sponsoring Senator Joe Simitian (D-Palo Alto). Under the bill, radiologists must include two additional sentences in the federally required letter sent to patients after a mammogram. They are, “Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office, and you should contact your physician if you have any questions or concerns about this notice.”
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Council Endorses Deficit Reduction Proposals
The Healthcare Leadership Council (HLC) earlier this week endorsed four deficit reduction proposals estimated to save $410 billion over 10 years. The council is urging Congress’ Joint Select Committee on Deficit Reduction to create a Medicare Exchange in which private plans would compete on cost, quality, and value; gradually increase the Medicare eligibility age from 65 to 67; reform Medicare’s cost-sharing structure; and implement medical liability reforms, including a cap on non-economic damages. HLC President Mary Grealy says the recommendations would “contribute to deficit reduction without placing an unfair or disproportionate burden on patients, health care consumers or our most vulnerable citizens.”
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OCTOBER
2011 RBMA Fall Educational Conference
Sponsored by the RBMA
October 16–19
Aria Resort and Casino
Las Vegas, Nevada
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2011 Community Hospital Executive Management Conference
Sponsored by Community Hospital 100
October 23–25
Pinehurst Resort
Pinehurst, North Carolina
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Economics of Diagnostic Imaging 2011
Sponsored by ESI Educational Symposia
October 27–30
The Ritz-Carlton Pentagon City
Arlington, Virginia
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NOVEMBER
RSNA 97th Scientific Assembly and Annual Meeting
Sponsored by the RSNA
November 27–December 2
Chicago, Illinois
Register >>
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