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Too Much Health Care?

by Curtis Kauffman-Pickelle

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. We do, indeed, allocate quite a bit more to health care, at 16% or so of the gross domestic product (GDP), than other nations do. By way of comparison, Japan, a country in the top three economies in the world, spends about 8% of its GDP on health care. How do we know, however, that 16% is too much? One author suggests that health care is being unfairly singled out, citing the 20% of our GDP allocated to manufacturing as an interesting example of a segment of society where the benefit has been more clearly delineated, understood, and accepted.

In a recent issue of The Wall Street Journal, author Craig S. Karpel¹ made the case quite persuasively that our national health care spending could be right in line; in fact, we might not be spending enough on health care. Now, that is an interesting argument that I don’t hear enough about these days. Indeed, I have often thought that far too much attention is paid in Washington, D.C., to the one segment of the economy that is doing fairly well, despite the dramatic downturn in our financial systems and the resulting recession.

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OIC Reimbursement: The Multipronged Attack

by George Wiley

In an illustration used for hospital clients, analyst Shay Pratt pinpoints imaging centers for sale around the country: four independents on the market in California, a four-center chain in Kansas, and a larger chain in central Florida with an asking price of $22.5 million. The list, with size and price variations, continues from coast to coast.

“We talked with our member hospitals and completed 250 research interviews with different radiology departments. We asked them if they had been approached by someone wanting to sell an imaging center, and at least 75% said they had.”
—Shay Pratt, The Advisory Board Co

Shay Pratt

Pratt is managing director of the Imaging Performance Partnership for The Advisory Board Co, a Washington, DC-based company that provides best practices and strategic research to more than 2,700 hospital and health system members. He presented “The Future of Imaging Reimbursement” on June 10 in Orlando, Florida, at the 2009 Radiology Summit sponsored by the RBMA.

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DR Done the Right Way

by George Wiley

If service, patient safety, and profit weren’t incentives enough, now hospitals and imaging clinics have another inducement to go digital: the Obama administration’s federal health care stimulus plan, which stresses health care IT and electronic medical records.

Steven Mendelsohn, MD, says, “The only choice to make is whether you go with DR or CR. Still using film makes no sense.” Mendelsohn is medical director of Zwanger-Pesiri Radiology, which operates eight imaging clinics in Long Island, New York. Deciding where to put DR and when to use CR depends on the practice and needs to be analyzed, Mendelsohn adds. “There is no one solution,” he says.

Steven Mendelsohn, MD

To make a long history short, CR preceded DR as a way to capture x-rays electronically, but CR uses a removable-plate image-capture system that is a lot like film-based radiography in that a plate must be transported to a reader, where it can be made into an image. DR, on the other hand, contains the image receptor permanently embedded inside the table or wall-mounted surface against which the patient lies or stands. With DR, the image is available on a monitor in the radiography room within seconds, and the technologist can verify it and send it to PACS from the radiography room itself.

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Forging Multigenerational Teams in Radiology

by Kris Kyes

A satisfied generation X worker is getting more than a paycheck—and is doing more than following instructions, according to Lisa Landry, MBA, MRT(N), Children’s Hospital of Michigan, Detroit. Landry is a member of generation X, so she brought an insider’s knowledge to “Satisfying Generation X: Building Effective Teams and Promoting Consensus Decision Making,” which she presented on August 12 in Las Vegas, Nevada, at the 2009 annual meeting of AHRA: The Association for Medical Imaging Management.

Decentralized decision making is supported by the team concept, provided there is completely open discussion of which tasks are necessary, who will perform them, when they should be completed, and how their effects will be measured. Managers must be careful not to create a parent–child relationship with the team, aiming for interaction among adults instead and overcoming any urges to control the team.

Today, as the eldest members of the baby-boom generation reach retirement age, most of the people on the payroll of any imaging department or practice now come from that generation or from the two following generations, X and Y. This means, Landry notes, that employees from the silent generation (born between the mid-1920s and the mid-1940s), who may automatically bow to convention and authority and tend to accept orders without questioning them, are now rare, and most are approaching retirement.

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Hybrid Radiology Model Merges On-site Radiology With Remote Reading

by Cat Vasko

In 2005, Lima Memorial Health System (LMHS), Lima, Ohio, was managing its 100,000 imaging studies per year through a traditional hospital–radiologist relationship. LMHS contracted with a 10-member radiology group that handled all of the health system’s imaging, and according to a longstanding policy within the group, each member was paid an equal share of its total earnings. “That’s how the group was built, and that was its approach to doing business,” Bob Armstrong, senior vice president and COO of LMHS, recalls.

As younger radiologists joined the group, however, things began to change. “They brought in younger subspecialists who had expectations of making more money, and that created a lot of tension that began to unwind the cohesion within the group,” Armstrong explains. “There was a power struggle.” In 2006, the group held a meeting and voted to move to a model wherein each radiologist brought home what he or she earned. “When the group finally decided to change the model, it went from 10 members down to five,” Armstrong says. “We once had a very strong group, and now we had a fractured group.”

Bob Armstrong

Armstrong elected to continue working with the halved radiology group, contracting separately with one of the group’s former members, a mammographer, to ensure that breast studies at LMHS would continue to be read. “We wound up with two separate radiology groups,” Armstrong says. Though LMHS was hopeful that the makeshift solution would work, the complaints soon started rolling in, both from the hospital staff and from the radiologists themselves. Before long, Armstrong’s office was fielding three or four complaints per day.

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MIPPA’s Impact on Imaging

by Steve Smith

At the 2009 annual meeting of AHRA: The Association for Medical Imaging Management in Las Vegas, Nevada, on August 12, two representatives of the ACR presented “Quality and Safety Response to National Initiatives.” The information was presented by Krista Bush, ACR director of diagnostic modality accreditation and director of the nonbreast imaging accreditation programs, and by Judith Burleson, ACR director of metrics.

The focus of their presentation was on explaining the impact on radiology of the Medicare Improvements for Patients and Providers Act (MIPPA), passed by Congress in July 2008, and they also presented updates on pay-for-performance value-based purchasing. According to Bush and Burleson, medical imaging facilities should gird themselves for increased scrutiny in the areas of quality and efficiency.

MIPPA has six key provisions. First, the law blocked the 10.6% cut in physician payments that was scheduled for July 1, 2008, and it provided a 0.5% update through the end of 2008. It also blocks the 5% cut scheduled for 2009 and provides a 1.1% update for 2009. Second, it reapplies the budget-neutrality adjustment for recent RVU changes to the conversion factor, rather than to work RVUs, effective January 1, 2009.

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Isotope Shortage Hinders Nuclear Medicine

by Cat Vasko

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. The 51-year-old reactor, which has been inoperative since May owing to a heavy-water leak, needs repair in at least nine areas, according to the AECL. The loss of the NRU reactor had already created a shortage of medical isotope technetium Tc 99m; when another reactor in the Netherlands was shut down on July 18, US supply of the radionuclide became severely limited.

“As physicians on the front line, we want the most appropriate test to answer the question at hand in as timely a manner as possible. There are only a handful of these reactors around the world, and they’re all aging. We’re having this problem now, we’ve had it before, and we will have it again in the future.”—Mylan Cohen, MD

Mylan Cohen, MD

Mylan Cohen, MD, president-elect of the American Society of Nuclear Cardiologists, characterizes technetium as “the workhorse of nuclear medicine.” The radionuclide, a product of the decay of molybdenum 99, is used in more than 40,000 imaging procedures daily in the United States.¹ “Technetium, when combined with various organic molecules, is used to target a number of organs to evaluate disease states,” Cohen says. “It’s used extensively in cardiology to evaluate blood flow to the heart, and it is also used to image cancer patients.”

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Enterprise Visualization: The CIO Story

by Rich Smith

When contemplating implementation of an enterprise-wide advanced visualization solution, expect to hear many concerns voiced by various stakeholders—and look for the CIO’s voice to be front and center among them. Topping the CIO’s list of concerns will most probably be whether (and to what extent) the proposed advanced visualization solution is scalable.

Duleep L. Wikramanayake is CIO for Advanced Radiology Consultants, Trumbull, Connecticut. He says, “If scalability is limited or missing, I wouldn’t even consider adopting that particular solution. The lack of scalability will leave you flat-footed. You’ll discover that your physicians love advanced visualization and will use it more and more often; soon, you’ll be fielding requests for more users and requests to save the studies longer. Only if you have scalability can you accommodate all this.”

Another CIO concern is proprietary versus open-source technology. “The best advanced visualization solutions in an enterprise environment are those that are as nonproprietary as possible,” Wikramanayake says. “Here’s why: Say you have an advanced visualization solution that is based on proprietary technology. It might be ideal for your needs, but then the brains behind that proprietary product decide to leave the company. With them go the company’s potential for making future enhancements to that product. Now you’re stuck with a solution that becomes increasingly less viable over time. You avoid all that by buying a solution built from off-the-shelf components.”

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