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Scanning Imaging’s Deals

by Curtis Kauffman-Pickelle

Among the more interesting dramas unfolding in the medical imaging profession these days are the number and variety of transactions that are either in the pipeline, in the process of due diligence, or otherwise in some organization’s strategic plan for 2010. Consolidation is one of the indicators of a maturing marketplace, and it is clear that imaging is maturing. Another indicator is commoditization, and when combined with the push for consolidation to find economies of scale, these factors have an enormous impact on the environment and climate for deals.

Hospitals are attempting to acquire OICs, immediately transforming them into more profitable practices through their ability to bill Medicare as provider-based entities, thereby leveraging the hospital’s strength as a market aggregator. These deals have emerged as the trendy option to show short-term gain for the two entities involved in the structure.

Strong and focused radiology practices are hoping to merge, acquire, or otherwise combine with weaker competitors in an effort to boost their market footprints, gain market share, or bulk themselves up in preparation for a future in which a practice’s size will be an increasing requirement for continued sustainability. These deals are springing up in what were once crosstown rivalries, and they are likely to continue to fuel the environment for alliance building.

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Software Allows Virtual PET/MRI Fusion

by Cat Vasko

It was a difficult, but not uncommon, neuroradiology case: A patient suffered seizures, but had, a year before, been cleared of the possibility of epilepsy by a radiologist looking at an MRI study of the patient’s brain. The persistence of the symptoms suggested that the initial diagnosis had been incorrect, so Meng Law, MD, professor of radiology and director of neuroradiology at the Keck School of Medicine at the University of Southern California (USC), Los Angeles, compared an MRI scan with a PET scan to look for the more subtle lesions that are characteristic of the disease.

“In patients with epilepsy, the lesions are often very subtle,”  Law says. “The MRI was done a year ago and read as being normal by a colleague, and the PET scan, done recently, showed very subtle abnormalities.”

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Evaluating Radiology’s New Revenue Streams

by Steve Smith

In January 2008, the ACR® appointed a task force to research and report on the efficacy of the increasing number of value-added services in radiology. Citing a rapidly changing business landscape for radiology services, the blue-ribbon panel was charged with the task of evaluating and providing insights into the value of evolving and novel business models for the practice of radiology. Its findings¹ are reported in the October 10, 2009, issue of Journal of the American College of Radiology: JACR.

In determining the focus of its research, the task force evaluated two variations on the new radiology business models. One was based on additional activities related to the usual practice of medical image interpretation. Here, the committee recognized the value of radiologist involvement in ordering, examination design, and discussion of examinations and results with patients. The other variation reviewed was a described as a nontraditional role that can add value in novel business models.

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ACR Economic Update: What to Expect From CMS in 2010

by Kris Kyes

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. Her predictions, largely confirmed by the final ruleissued by CMS on October 30, are a reliable guide to what imaging providers can expect from the Medicare program in 2010.

The regulatory changes made to the Medicare Physician Fee Schedule (MPFS) will not include any adjustments to physician work RVUs, Spillman-Dennis says. An overall reduction in physician payments of 21.2%, however, will go into effect on January 1, 2010, unless Congress overrides this cut based on the sustainable growth rate (SGR); legislative action has been used to prevent the annual SGR-mandated MPFS decreases in past years.

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Quality Control With A Custom Fit

by George Wiley

Less than a year ago, the radiology department at the Fletcher Allen Medical Center (FAMC), Burlington, Vermont, the hospital affiliate of the University of Vermont College of Medicine, was struggling with antiquated peer-review and quality-control (QC) methods. For peer review, according to Steven P. Braff, MD, radiology department chair, radiologists were relying on paper cards that had to be filled out by hand. Busy physicians balked at the added work, even though peer review is mandated by the Joint Commission and called for by the ACR®.

Moreover, Braff says, the FAMC radiology department had no way to formalize quality reviews of radiologic technologists. If radiologists noticed mistakes in a technologist’s imaging, they had to find a supervisor and follow a cumbersome reporting procedure.

There was a similar burdensome procedure for handling mistakes made by radiologists themselves. In this instance, Braff says, the radiologist who spotted a possible interpretation error had to take the awkward step of questioning the work of a fellow physician.

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Grassroots Coalition Puts Collaboration Above Competition

by Elaine Sanchez

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. In July 2009, however, they put competition aside for a common cause, and the Emergency Coalition to Save Cancer Imaging (ECSCI) was born.

Formed in response to cuts to medical imaging payment proposed by CMS, the coalition is a grassroots, nonprofit organization consisting of 72 New York OICs in Long Island, the five boroughs of New York City, and Westchester County. With more than 40,000 signatures (and counting) on its petition, the organization is calling for CMS and Congress to reevaluate a change in the Medicare fee schedule that will have a negative impact on the availability of mammograms, the group warns.

Cofounder Andy Wuertele, COO of East River Medical Imaging in New York, concedes that there are a few positive aspects of the recently released CMS final rule for 2010, but the general feelings of the coalition are frustration and concern about the long-term direction taken by CMS. “We appreciate the use of a four-year phase-in for the cuts, and that the contiguous–body-part cut was not included,” Wuertele says. “A delay or phase-in was a priority because it gives us an opportunity to fix this before the cuts become so big that they completely destabilize the providers.”

Wuertele says that coalition members felt that their efforts were less effective than those of some medical specialties that had better coordinated national responses. “Too many outpatient imaging stakeholders sat on their hands while other specialties delivered a broader and wider message that resonated with Congress and CMS,” he continues. “We are reaching out to additional groups across the country to work more closely together.”

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Extending Advanced Visualization Across Multiple Departments

by Rich Smith

Among the virtues of thin-client 3D advanced visualization are ease and economy of deployment across an enterprise. Above both, however, lies the ability to improve the quality of care. At Beebe Medical Center in Lewes, Delaware, which has extended access to its advanced visualization platform from the radiology department to the emergency department, critical care unit, and operating suite, thin-client advanced visualization is making a big difference.

Diagnostic radiologist Michael Ramjattansingh, MD, says that the technology played a decisive role recently in saving the life of a woman admitted to the emergency department with a complaint of chest pain that turned out to be caused by a rare, potentially fatal condition that no one expected to encounter. “She was bleeding into her chest; that much, the emergency-department team could determine in triage,” Ramjattansingh recalls.

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The Mayo Clinic Vision: Radiology’s Role in Care Delivery

by Cat Vasko

Integrated health care delivery systems such as that pioneered by the Mayo Clinic, Rochester, Minnesota, have been heralded for their low-cost, high-quality care and greater efficiency. With all eyes on potential new models for health care delivery—particularly in the imaging field, where skyrocketing costs and questions about appropriate utilization have created a climate ripe for additional cuts to reimbursement—ImagingBiz.com speaks with Glenn Forbes, MD, a radiologist at Mayo and former CEO of the Rochester clinic, on radiology’s role in the health system of the future.

ImagingBiz: Why has integrated delivery caught on in some markets, but not in others? What are the obstacles to this health care delivery model?

Forbes: Integrated delivery systems have caught the attention of a large segment of those discussing health care reform for a number of reasons. Some very demonstrable goals are being achieved in terms of outcome, delivery, and affordability, so people are wondering, what’s different about integrated delivery, and is that a template we should emulate? There are already many integrated delivery systems around the country. Some are large; others are smaller. At Mayo, we have worked on this model for over a century and have a lot of experience with it. Why does it seem to work in some areas and not others?

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