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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Keep Your Hospital Relationships Healthy: Strategies for Every Practice
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RIS to the Rescue | Strategies for Driving Revenue, Productivity and Profitability
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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.
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.
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.
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.
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.
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).
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.
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.
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.
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
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.
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
Preparing for Potential Reform: The Hospital View
Some proponents of national health care reform expect to pop the champagne corks any day now in celebration of getting a bill through Congress.
Using Next-generation IT Tools to Improve Appropriateness
It might well have been the unofficial theme of RSNA 2009 in Chicago, Illinois: “You can’t change what you can’t measure.”
Too Big to Understand
I just finished reading the new book about last year’s financial near meltdown, Too Big to Fail (Viking, 2009), by Andrew Ross Sorkin.
Window on 2010: Impact of Imaging-Specific Health Care Reforms
Since the dawn of the DRA at the close of 2005, health care observers have predicted a follow-on DRA II. It appears that this prediction will come to pass shortly after the clock strikes midnight on December 31.
Alternative Imaging Business Structures and Arrangements: What’s Legal?
The changing regulatory landscape for imaging business structures has left considerable uncertainty about which arrangements are acceptable in the eyes of the law
Now, for Something Completely Different
As I sit here trying to think of a way to wrap up a year of tremendous change in radiology, health care, and the economy at large, I understand that there is no way to turn 2009 into a neat package.
Malpractice Premiums: MIA in the Health Care Debate
Health reform efforts have developed into a heated and contentious debate.
Cost of Care to Elderly Soars
During the decade following 1996, the average annual cost of health care for those 65 and older increased 30%, according to a recent analysis.1
A Call to Action
Any reader of Radiology Business Journal knows that the complexity and intensity of managing a radiology practice are increasing exponentially.
The 50 Largest Radiology Practices
Our second annual survey indicates that the big are getting bigger, the average number of imaging centers owned is trending lower, and nearly all of the nation’s 50 largest private radiology practices are providing some level of teleradiology
Grassroots Coalition Puts Collaboration Above Competition
The rival groups had targeted the same pool of patients in their marketing efforts, positioning their respective imaging facilities, in one of the most competitive markets in the country, as the best that the Big Apple had to offer.
ACR Economic Update: What to Expect From CMS in 2010
While health reform is still a legislative preoccupation, where regulatory agencies are concerned, the train has left the station, according to Maurine Spillman-Dennis, MPH, MBA. Spillman-Dennis is a senior director in the economics and health policy division of the ACR®, and she presented an economic update from the college at the RBMA Fall Educational Conference on October 12, 2009, in Phoenix, Arizona.
Sunshine Bill Renews Focus on Conflicts of Interest
While health care players and politicians have long debated the issue of medical transparency.
Health Care Efficiency: No Miracle Cure
Health care reform ideas are everywhere these days.
DRA II: CMS Proposes Slashing the Technical Component Again
A proposed 90% equipment-utilization formula and brand-new lowball practice-expense data courtesy of the AMA will deal radiology a new round of cuts comparable to those contained in the DRA.
Now, the OIG Takes Aim
Yet another wearisome attack on imaging from Washington begs a question: Will decision makers ever get to the real roots of health care inefficiency?
Isotope Shortage Hinders Nuclear Medicine
It was the worst news that the nuclear-medicine community could receive when, on August 12, Atomic Energy of Canada Ltd (AECL), Chalk River, Ontario, announced that the National Research Universal (NRU) reactor would remain shut down until at least January 2010.
OIC Reimbursement: The Multipronged Attack
In an illustration used for hospital clients, analyst Shay Pratt pinpoints imaging centers for sale around the country
Too Much Health Care?
Of all the issues facing today’s imaging executives and radiologists, none sounds more cacophonous than the nearly universal cry that the United States spends too much on its health care.
Radiology Braces for Change Ahead
Some US employees still enjoy Cadillac-style health plans in which little is paid out of pocket and coverage includes almost every health need, but health care costs for its workers helped send Cadillac maker General Motors into bankruptcy.
The Invisible Radiologist Meets the New Math, Climate Change, and Business 101
A leading industry analyst suggests that radiology practices and hospital imaging executives must adapt to the new order or risk extinction
The 25% Administrative Complexity Conundrum
A modest 10% optimization of health care’s administrative processes would save the US health care system $500 billion over 10 years.
Adding Patient Value to Health Care
Harvard professor, best-selling business author, and management consultant specializing in competitive advantage Michael E. Porter, PhD, offers his free-market spin on health care reform¹ in the July 8, 2009, issue of the New England Journal of Medicine.
Against the Sword of Damocles
Radiology will fare better under reform than in its absence; it is advisable to join the battle
The Demise of Reason (and Eating Crow)
When politics enters the health care debate, reason departs
Quantifying Imaging’s Value to Patients
Contrary to popular belief among regulators and payors, imaging studies do, in fact, contribute to improved patient care.
Health Care Reform and Medical Imaging: The 10,000-foot View
The Obama administration is pursuing an aggressive timetable to deliver on a campaign promise to make affordable health care available to all US residents.
MSDRGs: Pitfalls and Opportunities
Ernest Glad, president of Cortell Health, Dallas, Texas, sees the 2007 CMS restructuring of the DRGs used in the inpatient prospective-payment system as an opportunity that many hospitals are currently squandering.
Coalition Forms to Promote Clinical Decision-support Tools
In June, an alliance of health care providers, technology vendors, and imaging organizations announced the formation of the Imaging e-Ordering Coalition
Radiology and the Culture of Money
Let’s get the full disclosure part out of the way right up front.
RBMs: The Debate Heats Up
After a false start, RBMs have come on strong, but the advent of computerized physician order entry leads some to believe there are better ways to control imaging utilization
Pandora and the Very Scary Box
Out of the box flew all of mankind’s misfortunes
Radiology and the Culture of Money
Let’s get the full disclosure part out of the way right up front.
2009 MedPAC Report: A New Threat to High-quality Care
In 1997, Congress created the Medicare Payment Advisory Commission (MedPAC) to provide recommendations regarding health care policy and reimbursement with respect to the Medicare program.
Grassroots Activism 101
War stories from the first assault on imaging.
Health Care Tomorrow: A Revisionist Preview
Jeff Goldsmith predicts that, despite inevitable changes, the future of health care is more sound than many people believe.
Extreme Subspecialization Builds Its Own Knowledge Base
“The more you see, the better you are,” Javier Beltran, MD, FACR, says.
Breakeven Modeling for a Multimodality Imaging Center
In the 1980s and 1990s, payor fees were generous for the newest modalities, and most freestanding imaging facilities were quite profitable.
ARRA Update: Opportunities and Risks for Health IT
The American Recovery and Reinvestment Act of 2009 (ARRA)
Recovery Audit Contractors: Coming Soon to a Provider Near You
Medicare providers and suppliers nationwide have been preparing for increased Medicare audit activity in anticipation of the nationwide rollout of the permanent Recovery Audit Contractor (RAC) Program.
MGH Decision-support Study: A Shot Across the RBM Bow
A new study¹ finding that radiology order-entry (ROE) and decision-support (DS) tools act to curtail utilization rates for advanced imaging is being celebrated as proof that a White House proposal to deploy radiology benefit managers (RBMs) as Medicare gatekeepers is unnecessary and ill conceived.
CMS Decision on CTC Prompts Restrategizing
The CMS decision to retain nonapproval status for CT colonography (CTC) as a screening method for Medicare patients was a bitter pill for radiology to swallow—all the more bitter because, prior to the February 11 decision, the mood had been optimistic.
Prove It
It is time for the specialty to take a proactive role in evidence-based radiology
Further TC Cuts Ahead?
Due to inequities in payment methodology, are providers of imaging services overpaid?
Under the Influence of RBMs
It’s no secret that utilization control has emerged as the method of choice for private payors focused on reining in imaging costs.
Health Reform’s Shortest Era
He came. He saw. He vanished. Just as we health care journalist types were lining up the margins and checking references on our various predictions of what Tom Daschle would bring to the health reform debate and process, he bequeathed his White House office to his deputy in waiting.
ACR and RBMA Update on Congressional Activities and Medicare Payment Policies
On December 16, 2008, the RBMA hosted a Webinar to update members on ACR congressional activities and Medicare’s payment policies for 2009.
The Outpatient Imaging Forecast Is Mixed, but Growth Is Ensured
In November 13, 2008, GE Healthcare, Waukesha, Wis, hosted a webinar entitled Interpreting the Future of Medical Imaging.
Revised Anti-markup Rule: CMS Gets Creative
On November 19, 2008, CMS issued the Medicare Physician Fee Schedule (MPFS) for calendar year 2009.
The 50 Largest Radiology Practices
Why compile a list of the 50 largest radiology practices? We acknowledge that the list is far from complete, and that there may be some inconsistencies in the way that respondents answered the questions.
Health Care Delivery, Undisrupted
How to afford health care is not the question we should be asking in these times of unsustainable health care cost increases.
Maintaining a Steady Aim at a Moving Target
An overview of recent regulatory changes affecting diagnostic imaging
Busting Myths: Joint Ventures
Radiology groups should understand the tax implications of arrangements with hospitals before they begin negotiations, according to W. Kenneth Davis, Jr, JD.
Major Advances in Osteoporosis Assessment: New NOF Guidelines and the’s FRAX Risk-assessment Tool
Osteoporosis is a major public-health problem, with an estimated 44 million US residents at risk for fracture.¹
Regulatory Report: Gains Made in Campaign to Limit Self-referral
Organized radiology has been devoted to the self-referral issue for more than a decade.
Time to Unwind, and Other Effects of the 2009 MPFS
Few federal rules for billing and leasing of diagnostic testing equipment and technicians by mobile testing companies will require the restructuring or unwinding of many imaging arrangements prior to the end of 2008.
Evaluating Mergers and Acquisitions
The forces driving mergers and acquisitions in imaging will only intensify, according to the presenters of Legal and Regulatory Issues Facing Outpatient Imaging Centers.
New Rules of the Game: Medical Directors Assume the Quality Burden
Demand for radiologists acting as medical directors could jump if a proposed regulation now under consideration by CMS is adopted.
The Dynamics of Reimbursement and High-quality Care
Access to high-quality patient care is a cornerstone of customer-focused service delivery, Michael A. Silver, PhD, says.
The Next Wave: Compliance With Medicare IDTF Standards Requires Ongoing Diligence
To say that the health care regulatory environment has been active over the past two years would be an understatement.
Economic Summit 2008: Audience Response
A survey of attendees at a May 2008 meeting has yielded a snapshot of today’s primary concerns for radiology practices.
Minnesota’s Bold Experiment: Radiologist as RBM
In June 2008, the Government Accountability Office (GAO) released a long-awaited study on imaging utilization.
Contest of the Implausibles
In an often-hilarious talk at the Beyond Conference in Washington, DC, on July 24, 2008.
CMS Proposes Changes to the Anti-Markup Rule: Round Two
The only constant is change is an apt mantra for the imaging industry over the past several years.
Proposed 2009 MPFS: Once Again, Imaging Takes a Disproportionate Impact
In what seems to be becoming as much a harbinger of summer as fireworks or cookouts, on July 7, 2008, CMS published its proposed Medicare Physician Fee Schedule (MPFS) payment update for the next fiscal year.
Recovery Audit Contractors and Medicare Audits: Successful Strategies for Defending Audits
The CMS Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide, beginning this year.
CT Colonography: Ready for Prime Time
On June 18, 2008, a letter was sent to the CMS Coverage and Analysis Group seeking approval of CT colonography (CTC) as a generalized screening tool for colorectal cancer among asymptomatic Medicare patients 50 years of age or older.
Precertification: The Provider Foots the Bill
Is radiology benefit management (RBM) companies extend the reach of precertification and preauthorization programs, hospitals and physician practices across the nation are incurring significant personnel and software costs in their efforts to manage program requirements.
Radiology Income Distribution: From Salary to Independent Practice to Megapractice
A CPA offers his perspective on the past and future of radiologist compensation, based on 30 years on the business side of radiology
Ethics, Steerage, and a Level Playing Field
How you feel about the issue of patient steerage depends, of course, on whether you are the beneficiary of a steady stream of unsuspecting patients being directed your way by payors determined to control every aspect of the delivery system.
RBM to Broker Teleradiology Services
A corporate offshoot of radiology benefit management (RBM) company MedSolutions, Nashville, Tenn, has begun marketing a program of subspecialized teleradiology services to payors.
Legislative Report: Another Temporary SGR Fix Is in the Wings
The CMS Sustainable Growth Rate (SGR) is again the center of attention for the medical community.
Trends in Mergers and Acquisitions in the Diagnostic Imaging Sector
There is little question, and ample evidence, that merger-and-acquisition activity in the diagnostic imaging business sector has increased since the Deficit Reduction Act (DRA) in 2005, and since Medicare Physician Fee Schedule changes and IDTF Standards changes in 2006 and 2007.
Contract Evaluations: The Devil in the Details
An adage of the legal profession holds that if you’ve seen one contract, you have seen exactly one contract.
Ten Trends, Five Years: Predictions for Outpatient Imaging
While long-term forecasts are always subject to error in a changing climate, today’s market trends can provide strong, reliable indications of what to expect in the future.
2008 Update on Non-hospital-based Outpatient Medicare Reimbursement
As part of GE Healthcare’s commitment to ongoing monitoring of the reimbursement situation, GE presented a Webcast on this topic on May 7, 2008.
CHAMP, Sustainable Growth Rate Reform, and Other Potential Payment-reduction Vehicles
Today’s imaging market is substantially different from that of earlier years; payment is less secure, coverage for new technology is more difficult to obtain, and government and private oversight are increasing.
Radiology’s Next Big Policy Fight
A conversation with Jeff Goldsmith, PhD, is, by definition, unpredictable and always provocative.
Outpatient Imaging Forecast: More Volume, Slower Growth, Heightened Competition
Strong growth, particularly for advanced imaging studies like CT, MRI, and PET/CT, has increased imaging volumes and profits at an unprecedented rate over the past decade.
National Health Spending for 2006
EACH YEAR, THE CMS OFFICE of the Actuary and the National Health Expenditure Accounts (NHEA) Team compile figures reflecting US health expenditures, and the results are published, with analysis, in Health Affairs.
Hospitals Still Outnumber Imaging Centers but the Gap Is Closing
Diagnostic imaging centers continued their growth trajectory well into 2007, according to the latest Diagnostic Imaging Center Report from Verispan, Yardley, Pa.
Trends in Imaging Arrangements
Prior to 2007, medical practices that developed and used imaging facilities on an exclusive, full-time basis were not overly scrutinized by payors or regulators.
A Thorny Question: Who is Responsible for Transcription Costs?
Radiology practices and hospitals historically have operated under the assumption that the cost of transcription is part of the technical component, and therefore the responsibility of the hospital, or the entity that owns the technology.
The Shifting Landscape of Cardiac CT Angiography Reimbursement
Many imaging providers have been wishing for changes in reimbursement policies for cardiac CT angiography (CCTA) for some time.
