The Industrial-strength Imaging Executive
by Curtis Kauffman-Pickelle
Today’s medical-imaging profession is definitely not for the fragile and weak-kneed among our colleagues. It is becoming increasingly clear that navigating the constant changes and challenges that face the practice of radiology today will be the ultimate test of tenacity, perseverance, and creativity. We’re in the playoffs now, and the game is moving to the big-time arena—where the margin for error is nil.
Finger in the Wind
by Cheryl Proval
Physicians are in a real bind as fee-for-service reimbursement falls under attack and alternative payment methods (such as bundling and capitation) gain traction in Washington, DC. As of June 18, Medicare Part B claims were being processed with the 21.3% cut mandated by the sustainable growth rate’s formula, and House Democrats demanded legislation on jobs before they would pass the Senate bill to reverse the cut.
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July 20, 2010 11am ESTTopic
Keep Your Hospital Relationships Healthy: Strategies for Every Practice
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Randy Roat, CHBME, VP of Radiology, MMP, and George Ehrhardt, CPA, Director, Practice Management, MMP
Medical Management Professionals, Inc.
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RIS to the Rescue | Strategies for Driving Revenue, Productivity and Profitability
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Advanced Visualization | Next-generation Architectures
Visage Imaging
Debunking the Primary Myths of PACS
The road to PACS perfection is paved with distractions and pitfalls, Paul Chang, MD, FSIIM, says. Chang is professor of radiology, vice chair of radiology informatics, and medical director of enterprise imaging at University of Chicago Medical Center in Illinois. During the 2010 Dwyer Lecture, “The Role of Imaging Informatics in the Next Generation of EMR/EHR,” presented June 4, 2010, at the meeting of the Society for Imaging Informatics in Medicine in Minneapolis, Minnesota, Chang used the experiences of other industries to debunk common PACS myths—and to illuminate next-generation requirements for imaging.
Fail-safe: Automating Critical-results Notification
The radiology department at Brigham and Women’s Hospital (BWH), Boston, Massachusetts, created a policy for communicating critical and discrepant results after the Joint Commission made communications among caregivers a national priority for health-care providers. When the goal was expanded in 2007, the department took the next step and used IT to automate the process and to embed it into radiologist and referring-physician workflow.
Radiologue: Whole-system Communications for Radiology
The San Francisco General Hospital/University of California–San Francisco Department of Radiology has created a groundbreaking communications tool called Radiologue. Alexander V. Rybkin, MD, a radiologist in that department, described the system in “A Web-based Flexible Communication System in Radiology,” which he presented in Minneapolis, Minnesota, on June 5, 2010, at the annual meeting of the Society for Imaging Informatics in Medicine.
The Economic Case for Patient-friendly Imaging
As the technology used for radiologic studies matures, providers and referrers are increasingly focused on providing patients with a friendlier imaging environment—with good reason, according to Tariq Gill, MD.
Sparking the Storage and Sharing Revolution: Symantec Health’s Lori Wright
Radiology has a storage problem, to put it lightly: Even as the data associated with a single cross-sectional imaging study increase dramatically, HIPAA requirements to ensure patient privacy remain as stringent as ever.
The SGR Fix Passes With a 2.2% Update
The familiar, contentious debate surrounding Medicare’s sustainable growth rate (SGR) formula came to a temporary close on June 24, when the House of Representatives, by passing HR 3962, finally agreed to a Senate plan to put off a 21.3% decrease in payment rates.
Beyond the Basics: Next-generation Radiology Reports
At Shields Health Care Group (SHCG), an outpatient high-end imaging provider headquartered in Quincy, Massachusetts, staying ahead of the technology curve has been a clearly defined business initiative from the beginning.
New Radiology-department Solution Opens New Doors
Integration has been a buzzword in the radiology community for some time, and the team at Valhalla, New York-based Westchester Medical Center (WMC) knows why.
The Industrial-strength Imaging Executive
Today’s medical-imaging profession is definitely not for the fragile and weak-kneed among our colleagues. It is becoming increasingly clear that navigating the constant changes and challenges that face the practice of radiology today will be the ultimate test of tenacity, perseverance, and creativity. We’re in the playoffs now, and the game is moving to the big-time arena—where the margin for error is nil.
Health Reform’s Impact on Imaging
Plenty remains unknowable about the incipient impact of the Patient Protection and Affordable Care Act of 2010 (PPACA), but the act does stand to affect imaging providers, specifically through its compliance, fraud, and payment provisions, many of which have already taken effect or will take effect in the near future.
Succession Planning for Health-care Organizations
According to a 2004 study by the American College of Healthcare Executives, only 21% of 722 hospitals routinely engaged in leadership-succession planning, compared with two out of three for-profit companies in other industries.
Health Care’s New Financial Outlook
A window of access to capital has opened for hospitals, according to Lisa Goldstein, because of the improvement in the debt markets seen over the past six to nine months.
The Message Is the Medium
As a journalism and media student in the early 1970s, I was exposed to what was just then emerging as an entirely new way of aligning the creators of information with those who were hungry to receive it.
Studies Support Error Theory
Much of the evidence said to support the theory that radiology subspecialists make fewer mistakes than their generalist colleagues is anecdotal.
Subspecialty Radiology: Beyond the Debate
While debate continues to swirl around the future of general radiology, the marketplace is clearly moving toward subspecialization and the real-world challenges that it presents.
A Health-reform Primer for Providers
Tie your laces and get into the game, because reform, as viewed by the president of Kaiser Permanente Southern California, will initiate a period of great experimentation in health-care delivery.
From Partner to Employee: The Captive Radiology Practice
The hospital-employed model and the proliferation of corporate teleradiology providers are causing more radiologists to choose employment over partnership.
Setting Up a CCTA Service
Your hospital just installed a new multidetector CT (MDCT) scanner of 64 slices or more, and your emergency-department physicians are clamoring for a 24/7 coronary CT angiography (CCTA) service; now what?
The Road to Acceptance: CCTA for Chest Pain in the ED
The case for coronary CT angiography in the emergency department grows stronger every day, offering radiology practices that can deliver 24/7 interpretations a foothold in the exclusive field of cardiac imaging.
Pat Basu, MD, MBA: The Radiologist in the White House
While radiologists have served in prominent positions in Washington, DC, in the past, none have ever served as White House fellow and special assistant to the president before the recent appointment of Pat Basu, MD, MBA, as one of 13 men and women to serve in the 2010–2011 class of fellows.
Dissecting a Mantra: Doing More With Less
Whenever the economic aspects of business get tough, do more with less is a phrase heard everywhere.
Operating an Imaging-center Chain in the Postapocalyptic Era
It began with the DRA, and ever since, CMS and Congress have set upon outpatient imaging like dogs on a bone, culminating in a new round of cuts to the technical component contained in the health-reform law. As a result, operations at many outpatient-imaging organizations came into acute focus in 2005, and they continue to be scrutinized.
Mindful Cost Cutting
Consider this scenario: You have exercised your duties as a manager over the past several years by cutting costs where possible, but now, you have been ordered to make further administrative cost reductions of 10%, 20%, or even 30%, and you cannot fathom how it will be done. Does this sound familiar?
Can Decision Support Supplant Precertification?
Radiology decision support could qualify as meaningful use
Finger in the Wind
Physicians are in a real bind as fee-for-service reimbursement falls under attack and alternative payment methods (such as bundling and capitation) gain traction in Washington, DC. As of June 18, Medicare Part B claims were being processed with the 21.3% cut mandated by the sustainable growth rate’s formula, and House Democrats demanded legislation on jobs before they would pass the Senate bill to reverse the cut.
Helpful Sites for PQRI
Helpful Sites for PQRI
Business 101: Goal Setting and Strategic Planning
This article is the second installment in a four-part series on applying basic business concepts to radiology.
A Step-by-step Guide to Implementing PQRI
The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system.
Have RIS/PACS, Will Travel
For over thirty years, Radiation Physics Inc (Beltsville, Maryland) has been providing mobile imaging services to the Baltimore and Washington, DC, metropolitan areas, serving long-term–care and assisted-living clients, as well as prisons and private residences.
Employing a Differentiation Strategy
Attracting referrals is more crucial than ever for imaging-center operators who hope to see their facilities survive, and even thrive, in these difficult times
Effective Quality Assurance: Obstacles and Pointers
As the radiology marketplace matures, becoming increasingly competitive, it’s more important than ever for practices to differentiate themselves based on quality, according to Peter Franklin, MD, chair of radiology for Radisphere National Radiology Group, Cleveland, Ohio.
Scenario Planning for Health-care Organizations
If you’re not scenario planning, you’re not planning. This bold assertion, issued in a recent white paper by GE Healthcare, is the driving philosophy behind the company’s $6 billion healthymagination initiative, and is an approach that it hopes to spread among health-care organizations.
New Requirements for Documenting Imaging Orders
CMS published an interim final rule (with a comment period) on May 5, implementing several changes to the Medicare and Medicaid programs mandated by the Patient Protection and Affordable Care Act (PPACA).
Radiology’s New Normal
Don’t think that you are alone if the current uncertainty in virtually all aspects of medical imaging is driving you to distraction. Today’s radiology marketplace/profession has become increasingly complex, hypercompetitive, and extremely tense; the traditional relationships are in a constant state of flux.
Innovation From the Outside In: Olivia Ho Cheng, CEO of Aurora
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).
Summary of States’ Transparency Laws
More than two dozen states now have laws mandating transparency in health-care pricing, in some form or another—including everything from pilot programs to full-blown implementations.
Price Transparency Gains Traction
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 Reconsolidation of Imaging Centers
Significant market trends, over the past few years, have affected the competitive environment between hospitals and physician-owned freestanding imaging centers.
ACR Unveils Breast MRI Accreditation Program
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).
Executing the Digital Transformation
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
Lost in Transcription
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.
Suggested Steps Toward Decommoditization
In the Journal of the American College of Radiology: JACR, Reiner and Siegel¹ recommended 12 measures that could reduce the commoditization of radiology.
Commoditization of Imaging: What to Do Now
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’s Big Yawn
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.
The Tortoise and the Stack Burner
It is all too common for practices to devalue organization building in the race to productivity
CEO Roundtable: Practice–Hospital Relations
Independent radiology practices grapple with declining technical fees, commoditization threats, and the hospital interest in captive practices, as practice CEOs face unprecedented challenges
How Hospitals Are Rethinking Imaging
Economic and market forces are prompting hospitals in two Ascension Health hospital systems to reengineer the delivery of imaging
The Cosmetic Frontier: BOTOX and Beyond
According to data¹ from the American Society for Aesthetic Plastic Surgery (ASAPS), the number of cosmetic procedures performed in the United States has spiked in the past decade; ASAPS estimates that injections of botulinum toxin A (BOTOX®, Allergan, Inc, Irvine, California) increased by over 3,000% between 1997 and 2003, while collagen injections increased by a more modest 79%.
Building an Efficient, Effective Women’s Imaging Service
In a niche notorious for its comparatively low reimbursement, every step along the care continuum must be patient focused…
Strategic Radiology: 15 Practices Align for Strength
A new, radiologist-owned corporation is taking tentative, careful steps toward a national practice
Tracking Radiation Dose: IT Implications
In February, the FDA announced a new initiative to reduce unnecessary radiation exposure from CT, nuclear-medicine, and fluoroscopy exams.
Rescuing Retirement
If you are like many physicians, you are lamenting the losses to your retirement plan after the financial meltdown. You might have lost a substantial amount, and you might wonder how you can quickly regain the losses.
Financial Justification for Imaging Equipment
Claiming a share of the capital budget for imaging equipment is not always hard, but it certainly can seem overwhelming.
Life After Sutter
When news spread that Sutter Health (Sacramento, California) planned to cut loose its long-time radiology provider in Sacramento in favor of a captive model, some observers wondered how Radiological Associates of Sacramento (RAS), a 76-radiologist practice founded in 1917, would survive.
The Problem With Physicians Like Him
Author Thomas H. Lee, MD, writes that the problem with medicine is people like him: primarily men, in their 50s and beyond, who learned medicine when it was more about art and less about money.
Capitation: An Inevitability Waiting to Happen
The author argues that health care (in general) and imaging (specifically) are on a 10-year track to capitation
When the Invisible Hand Meets an Immovable Object
In a coincidence worth noting, Adam Smith’s The Wealth of Nations was published in 1776, the year that our nation-to-be declared its independence from what was then the Kingdom of Great Britain.
Tracking Patient Radiation Dose: IT Implications
In February, the FDA announced a new initiative to reduce unnecessary radiation exposure from CT, nuclear-medicine, and fluoroscopy exams.
Imaging-center Valuation 2010: Post-reform Drivers
While the industry landscape has certainly changed significantly since Radiology Business Journal published my article on this subject three years ago, the primary factors that drive the desire to complete transactions and the valuations remain largely intact.
MIPPA Accreditation: 20 Months to Go
As the deadline inches closer, radiology providers around the country are scrambling to meet new CMS accreditation requirements for MRI, CT, and nuclear medicine.
Leading an HCO in an Era of Scarce Resources: Implications for Radiology
It’s no surprise that so many provider organizations threw their weight behind the recently passed health-reform bill. In 2009, 72% of hospitals reported increases in uncompensated care.¹
Radisphere National Radiology Group Launches
To further its aim of extending subspecialty radiology services to community hospitals, Franklin & Seidelmann Subspecialty Radiology, Beachwood, Ohio, recently announced the creation of a new company called Radisphere National Radiology Group
Bariatric MRI: Challenges and Work-arounds
ThedaCare is Northeastern Wisconsin’s largest community-owned health system; its numerous radiology units strive to provide the highest-quality imaging to attract new referrals while simultaneously retaining hard-won existing business.
Tapping the Rural Market: A User’s Guide
The emergence of PACS has given practices a chance to expand their business and boost revenue by tapping the rural hospital market.
Crystal Ball: Toward True Enterprise Image Management
As the potential role of informatics in transforming health care gains national attention, how are IT tools for imaging and image management evolving to improve clinical efficiency and bolster quality of care?
Five Steps to a CER Project Portfolio
In a recent article in the New England Journal of Medicine, Harold C. Sox, MD, chair of the Institute of Medicine (IOM) committee to set national priorities for comparative-effectiveness research (CER).
Comparative-effectiveness Research and Imaging: Insights and Ambitions
In addition to extending coverage to an estimated 31 million US residents, the recently passed HR 3590, the Patient Protection and Affordable Care Act.
Finding Value in Imaging-center Valuations
After unprecedented growth over the past two decades, freestanding imaging providers have found the past few years challenging.
The Tortoise and the Stack Burner
You know the tale. In the end, the steady pace of the tortoise won out over the supreme confidence and sheer speed of the hare; the hare simply did not value the focus, commitment, skill set, and tenacity exhibited by the tortoise.
Improving Health Care: There Are Apps for That
If Dan Hesse had told you, 25 years ago, that you’d be reviewing studies, monitoring patients…
Academic PACS: It’s Not Elementary, Watson
In the late 1990s, Yale School of Medicine, New Haven, Connecticut, implemented its first PACS
UPMC’s Rasu Shrestha, MD, MBA: Improving the Value Proposition of Imaging Informatics
The University of Pittsburgh Medical Center (UPMC), with 20 affiliated hospitals and 30 imaging centers in western Pennsylvania, could be seen as ground zero in the effort to digitize medicine.
Study: Imaging Improves Health Outcomes
Lower mortality rates are among the benefits delivered by diagnostic imaging, according to a study in the December 2009 issue of the Journal of the American College of Radiology: JACR.
Teleradiology Providers Open the Door to Cost Savings
Community hospitals, like their larger counterparts, continue to encounter financial challenges as they strive to deliver cutting-edge imaging services.
Enterprise Image Management: Bringing Cardiology Into the Fold
Harris County Hospital District (HCHD) is the public health-care system for the nation’s third most populous county (Harris County, Texas); with 44 locations, it generates 420,000 radiology procedures and 70,000 cardiology procedures each year.
Deadline 2012: MRI Accreditation
Under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, those sites providing the technical component of advanced imaging must have accreditation by 2012—but not all imaging centers are waiting for the deadline.
Business 101: Using Basics to Grow Revenue
As imaging centers nationwide look for new revenue streams to compensate for ever-declining reimbursement, the answer might be getting back to basics, according to Greg Thomson and Dan Simile Jr of Medical Management Professionals, Inc (MMP), Atlanta, Georgia.
Radiology’s Next Move
Imagine the situation facing radiology practices and their changing market relationships as multiple, concurrent chess matches.
Building the Fully Loaded HIE: Images on Board
With a health IT stimulus package valued at $19 billion1 in play, one of the least controversial subjects in the health-reform debate is the potential of health information exchanges (HIEs) to lower health care costs while improving efficiency and quality of care.
High Hurdles for HITECH Dollars
The indefinite path to qualifying for Health Information Technology for Economic and Clinical Health Act funds just came into greater focus, but it’s not to everyone’s liking.
HIE on the Horizon
In an attempt to aggregate health information beyond the proprietary realm of the Medical University of South Carolina (MUSC) in Charleston, Frank C. Clark, PhD, MUSC’s vice president of IT and CIO, currently is spearheading efforts to partner with several other health care organizations in the area to form a health information exchange (HIE).
Wide-open MRI
Advances in the field strength of open-bore MRI systems are also opening new doors for imaging providers.
From Here to Eternity: Extending the Franchise Through Distributed-reading Solutions
Few developments in radiology have been more productive (or disruptive) than the advent of PACS. To PACS, radiology owes its ability to increase productivity dramatically during the past 10 years, thereby conserving income levels at a time of diminishing reimbursement.
Interoperability: An Open-source Toolkit
Within radiology, interoperability and sharing information are among our most challenging and important tasks.
The 20 Largest Academic Radiology Practices
Radiology Business Journal brings you this inaugural list of the largest academic radiology practices with our usual caveat: We know that this list is not complete.
A Business Like No Other
Observations, predictions, and prescriptions for the imaging-center industry
An Urgent Case for Quality
Gary Becker, MD, outgoing president of the RSNA, read members the equivalent of the riot act in his presidential address on November 29 in Chicago, Illinois, kicking off the 2009 meeting and jump-starting the quality-improvement movement in radiology.
MRI: The Next Generation
MRI has come a long way since its inception, and it has yet to cease evolving. New developments continue to surface, bringing with them changes in radiology practice patterns and opportunities to bolster revenues by attracting new patient populations.
Implications of Reform for Hospitals: Seismic or Subtle?
Hospitals are keeping a wary eye on Washington, and on several key payor trends with major implications for imaging service lines, for good reason.
Relationships Gone Wild
All across the country, we are seeing the dissolution of long-time hospital–practice relationships that are part of the community fabric
When the FDA Sneezes…
Whipped to an overblown froth by media attention, the radiation-safety issue will, for better or worse, get the attention that it demands
The CIO Perspective: Issues in Image Management
Gone are the days when radiology managed image data in a silo: CIOs are engaged in imaging informatics.
New Templates for Recession-resistant Marketing
Marketing radiology services can represent a significant challenge, particularly in an increasingly consumer-driven medical marketplace, where outreach to patients requires reconfiguring a familiar line of messaging.
Radiology Practices Fight Declining Technical Revenues
Declining technical revenues have become a way of life for imaging practices.
Leveraging IT for Better Service
Don Trexler, CEO of Baton Rouge Radiology Group (BRRG) in Louisiana, wants his practice to be different from a typical imaging group.
Radiology Assistants: A User’s Guide
From May 2007 to January 2008, an Atlanta, Georgia-based radiologist signed and submitted thousands of reports in his name, with one major caveat—he didn’t review a single one.
Restructuring: The Way JVs Get Done
After Congress passed the DRA, reducing Medicare reimbursements for imaging services, the radiology landscape has never been the same.
Relationships Gone Wild
All across the country, in markets large and small, a drama once considered unimaginable is unfolding in ways that are shaking the confidence of many radiology practitioners and creating tension within the ranks of hospital administrators.
Preventing a MAC Attack: The Importance of Radiology Charge-capture Audits
The advent of Medicare administrative contractors has emphasized the importance of ensuring that charge capture is consistent and accurate for the professional and technical components of care.
Engaging Physicians in Hospital Radiology Quality Initiatives
The question of how to engage physicians in hospital quality initiatives “is one that many organizations are grappling with,” according to Albert Bothe, MD, chief quality officer for Geisinger Health System, Danville, Pennsylvania.
