THE BIG PICTURE

Radiology's Big Yawn
By Curtis Kauffman-Pickelle

Do you love your job? I'm not talking about every hour of every day, waking or sleeping, rain or shine—I know that there are times when all of us get frustrated with the ebb and flow of the daily routine. Do you generally care, though, about the choice that you made at the start of your career? If you're reading this column, you are one of roughly 35,000 professionals who made a conscious choice about their career paths and who are, for the most part, working as radiologists in a practice setting or as health-care executives in an institutional setting (such as an outpatient center, hospital, or health system).

The key concept here is choice. Unless you somehow had this career thrust upon you as an unsuspecting bystander, you selected it, studied for it, searched for a place to practice your craft, and settled into a profession that requires a certain amount of dedication and active community participation in exchange for security and a nice lifestyle.

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Commoditization of Imaging: What to Do Now
By Cat Vasko

The responsibility for the phenomenon has been placed, at one time or another, on the shoulders of just about every stakeholder in the imaging field. Some say that payors are to blame; others see the growing prevalence of remote reading as the culprit. Has the expansion of IT made it possible, or is radiology merely catching up with other areas of medicine?

"Radiology is a particularly sensitive area of specialization. We don't control our own patients, we rely almost entirely on referrals, and we're completely dependent on technology. There's still an opportunity to reverse the trend toward commoditization, but if we continue with the same modus operandi, we're headed on a downward spiral."

—Bruce Reiner, MD

Whatever your opinion of its origin, commoditization is clearly at work in imaging, according to Bruce Reiner, MD, director of research at the Maryland VA Health Care System in Baltimore. "There's an increasing focus on cost and a decreasing focus on quality," he says. "The government is the largest payor for health services, and they're constantly wanting to lower costs. There's an increasing focus on the bottom line."

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Lost in Transcription
By Andrew Casselberry, MBA

Charge reconciliation—the practice of identifying procedures that have slipped through the cracks at some point in the charge process and billing for them to optimize revenue—is important for any medical group, but particularly critical for imaging. Radiology is one of the most high-volume specialty areas in terms of both codes and procedures billed; radiologists can work through hundreds of interpretations per day, making manual charge capture a Sisyphean undertaking. Automating this process can help radiology practices reclaim a significant chunk of lost revenue; based on audits of hospital-based practices, the average error rate for charge capture ranges from 4% to 6%.

"By helping practices to focus on errors and exceptions (and benchmark their own performance), automated charge reconciliation not only boosts the bottom line by recapturing revenue that would otherwise be lost, but also enables savvy practices to identify the sources of problems, gradually reducing their risks of lost revenue from charges lost in transcription."

—Andrew Casselberry

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Executing the Digital Transformation
By Cat Vasko

When Saint Michael's Medical Center (SMMC), Newark, New Jersey, was acquired by Catholic Health East in 2009, the organization had some catching up to do in the IT department: With no PACS or electronic medical record (EMR), its clinical-informatics capabilities were behind the times. Angelo Schittone, vice president and CIO of SMMC, explains that when it was time to prioritize the many projects the hospital had been waiting to initiate, imaging was at the top of the list. "You have to look at the area where you'd have the most clinical impact and start there," he says.

Schittone says that a key area of dissatisfaction for many SMMC physicians was radiology reports' turnaround time, which averaged around two days prior to PACS implementation. "Forty-eight hours is just too long," he notes. "It was a major concern for our attending physicians. The PACS technology makes it easier for our radiologists to practice, but it also makes it easier for our other physicians."

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ACR Unveils Breast MRI Accreditation Program
By Julie Ritzer Ross

To enable imaging facilities to improve and maintain the quality of their breast MRI services, the ACR® has launched the Breast Magnetic Resonance Imaging Accreditation Program (BMRAP). Like other ACR accreditation programs, BMRAP involves peer-review assessment of imaging centers' processes and equipment, along with the caliber of their images and personnel.

Constance Lehman, MD, PhD, chair of the ACR Committee on Breast MRI Accreditation, says, "Imaging centers can fill out forms attesting to the qualifications of their staff and the quality of their services, as well as promote the integrity of the images they provide, but at the end of the day, it isn't enough. Accreditation is critical because it involves the thorough, repeated, objective evaluation of every aspect of facilities' breast MRI offerings. Only through that type of assessment can truly high standards of breast care be set and upheld."

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The Reconsolidation of Imaging Centers
By Elliott Jeter, CFA, CPA/ABV, & Todd Sorensen, AVA

Significant market trends, over the past few years, have affected the competitive environment between hospitals and physician-owned freestanding imaging centers. The primary drivers of these trends are the relative weaknesses of a large number of freestanding imaging centers (caused by changes in reimbursement and regulation) and the sensitivity of these businesses to the economic crisis. These changes in the landscape have created the ideal environment for a reconsolidation of imaging centers that can bring them back into hospital operations through acquisitions, perhaps at depressed market values.

Hospitals are using their newfound relative strength in certain key strategic areas opportunistically to acquire freestanding imaging centers in their markets. Some hospital advantages include reimbursement, access to capital, vendor relationships, and physician employment. Our company, VMG Health, has experienced a significant increase in the demand for valuation services, in the past year, in support of hospital acquisitions of freestanding imaging centers.

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Price Transparency Gains Traction
By Rich Smith

Owing to a confluence of market forces, industry innovation, and government action, consumers in more than half of US states now have at least some ability to see procedure charges in advance. The concept is to apprise patients of their out-of-pocket costs before they schedule appointments. Armed with such information, patients then can comparison shop and decide where to go for the most attractively priced services.

Massachusetts, for instance, shifted to this model of disclosure at the beginning of 2008. Jeff Ronner is CFO of Shields Health Care Group in Quincy (near Boston), which operates 33 imaging centers offering MRI, radiation-oncology, CT, and PET/CT services. Ronner says that one driver behind the push for transparency in Massachusetts was the burgeoning number of recession-hit businesses deciding to replace expensive, low-deductible benefit plans with more affordable, high-deductible insurance. Such plans compel patients to pay large out-of-pocket sums that can add up to several thousand dollars before the insurance company's contributions begin.

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Innovation From the Outside In: Olivia Ho Cheng, CEO of Aurora
By Cat Vasko

Olivia Ho Cheng, CEO of Aurora Imaging Technology Inc, North Andover, Massachusetts, was recently appointed to the international advisory board for the Britton Chance Center for Biomedical Photonics (BC CBMP), the first research laboratory focused on medical-imaging technology research and development in China. ImagingBiz spoke with her about the outside-in approach to research and development and the unique aspects of the Chinese marketplace that could make it a fertile breeding ground for new breakthroughs in diagnostic imaging.

ImagingBiz: Congratulations on being appointed to the international advisory board for the BC CBMP. You are among distinguished company that includes a Nobel laureate. What is the right time to bring a business perspective into a research institute? From your perspective, is it ever too soon?

Cheng: What we have found is that typically, a research laboratory or large university will take the inside-out approach: The researchers will conceptualize a product that has the potential to be very helpful, develop the product, and then try to find companies to commercialize it. On the other hand, at Aurora, we have taken the outside-in approach.

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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
George Wiley
Julie Ross
Rich Smith

NIH Issues Radiation Exposure Tracking Policy
The National Institutes of Health (NIH) will require all makers of CT systems and other radiation-producing medical-imaging devices used at NIH clinics to include software to track radiation dose and log it in an electronic medical record; the NIH will also require vendors to ensure that dose can be tracked by patients in their own personal health records. The organization is strongly encouraging all medical-imaging facilities to adopt similar requirements.

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Scenario Analysis for Radiology Practices
An article in the most recent issue of Journal of the American College of Radiology: JACR looks at scenario analysis and strategic planning for radiology practices. The authors outline practical and theoretical issues in using scenario analysis to improve a practice's planning process and discuss ways to apply this set of tools at a group meeting or retreat.

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NCI Contracts With ACRIN for CQIE Program
The National Cancer Institute (NCI) has awarded the ACR Imaging Network a contract to qualify NCI-designated cancer centers in the performance of advanced quantitative imaging, with the aim of creating a consortium of research sites with a proven capability to perform these procedures. Upon qualification, a cancer center will be called a Center of Quantitative Imaging Excellence.

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Health-care Employment on the Rise
Even as the US economy struggled, health care continued its employment rise in April, according to the US Bureau of Labor Statistics. The industry added 20,100 jobs last month, for a growth rate of 0.2%; hospitals added 6,100 jobs, or 0.1%, while physicians' offices lost 300 jobs from a workforce of 2.3 million.

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MAY

2010 Radiology Summit
Sponsored by the RBMA

May 23–26
The Broadmoor, Colorado Springs, Colorado

RBMA's annual meeting of radiology business professionals will feature extensive educational sessions presented by industry leaders, allowing attendees to share business challenges and solutions.

[More Information]

JUNE

SIIM 2010 Annual Meeting
Sponsored by the Society for Imaging Informatics in Medicine

June 03–06
Minneapolis Convention Center Minneapolis, Minnesota

SIIM's annual meeting will provide a comprehensive educational and scientific program for imaging informatics professionals, with highlights including vendor tie-in applied-learning sessions and the SIIM Annual Meeting Scientific Awards.

[Register]

2010 ANI Healthcare Finance Conference
Sponsored by the Healthcare Financial Management Association

June 20–23
Sands Expo Center and Venetian/Palazzo Resort Las Vegas, Nevada

The HFMA's annual conference on health-care finance will focus on the current economic and health-care climate, with sessions on reform, quality and cost, physician integration, the revenue cycle, and more. .

[Register]