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A Time for Introspection

by Curtis Kauffman-Pickelle

The question that I am most often asked is why I remain so confident and bullish about radiology’s future, given all of the bad news that continues to drain our collective will. Granted, medical imaging is under siege from the regulators, is in the crosshairs of the health reformers, and is not particularly embraced these days by hospital administration—and frankly, radiologists are not likely to be seen as those most in need of bailouts. It’s all rather gloomy and depressing—or is it?

Let’s put today’s trials and tribulations into a bit of radiologic perspective.

I recently learned about physician Takashi Nagai, one of the founding fathers of radiology who truly sacrificed himself for the greater good of humanity and the profession. Nagai was one of the people who, against all odds, helped create this fascinating profession of ours. His is a lesson worth thinking about when we bemoan the fact that the profession has disappointed us and has not proven to be inspiring or fulfilling. His story will awaken even the most apathetic among our colleagues.

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CT Radiation Dose on the Table

by George Wiley

Long a point of concern in Europe, radiation dose has emerged as a key point of consideration for pediatric radiologists in the United States, particularly with the development of multidetector CT. Recent headlines, however, have broadened the issue. Patients, referrers, hospital and radiology-department administrators, and CT equipment vendors are all looking for ways to minimize the radiation delivered during one or a series of CT exams.

“You can’t pick up a journal, whether for radiology or not, without an article about the radiation dose of CT,” according to E. Stephen Amis Jr, MD, FACR. “It’s the topic du jour.” Amis knows the landscape. He is the former chair of an ACR® Blue Ribbon Panel on Radiation Dose in Medicine and the current cochair of the Task Force on Adult Radiation Protection sponsored by the ACR and the RSNA. He also deals with CT radiation exposure on the day-to-day level.

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Strategies for Accommodating Self-pay Patients

by Cat Vasko

As the ranks of the uninsured continue to grow, it is increasingly important for radiology practices to implement strategies for dealing with self-pay patients, according to Randal Roat, CHBME, and Jana Landreth, CPA, MBA, of Medical Management Professionals (MMP), a physician billing and practice-management company based in Atlanta, Georgia. Based on a dataset of around 50 geographically disparate sites, Roat, vice president of radiology services for MMP, has seen an 11% increase in uninsured patients from 2008 to 2009 in the hospital environment; in the imaging center environment, that increase was a more measured (but still alarming) 5%.

Practices also might face difficulties in dealing with insured patients. As deductibles rise and copayments represent an increasingly high percentage of the overall cost of a procedure, Roat cautions that there’s more out-of-pocket payment, even among the insured.

“We need to be a lot more flexible and creative in how we work with our patients to allow them to pay for the services that we render.”
—Randal Roat, CHBME, vice president, radiology services
Medical Management Professionals, Atlanta, Georgia

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The Quest for Quality in Radiology

by Kris Kyes

With Quality Counts as its theme for 2009, the RSNA’s 95th Scientific Assembly and Annual Meeting in Chicago, Illinois, obviously emphasized multiple aspects of quality assurance, control, and improvement. On December 1, several multispeaker sessions had an even stronger focus on the practical steps that radiology providers can (and should) take to promote high quality in their operations and in their staff performance. Three of the presenters were particularly generous in sharing their experience and insight.

Jonathan B. Kruskal, MD, PhD, is chair of the department of radiology and director of quality assurance at Beth Israel Deaconess Medical Center, Boston, Massachusetts, and is a professor of radiology at Harvard Medical School. He presented “Anatomy and Pathophysiology of Errors in Radiology Practice,” stressing that the quality-improvement field is beset by myth in some areas. For example, it is often believed that errors are random occurrences, but they are actually attributable to factors that can be detected and corrected. Likewise, he says, the notion that properly trained professionals rarely commit errors is false.

James R. Duncan, MD, PhD, associate professor of radiology in the division of interventional radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, noted the importance of analyzing and then preventing these professional errors in “Assessing Physician Performance.” This process is vital not only to improving patient care but to enhancing public perception of the value of imaging services. He says that members of the public are “spending an incredible amount of money on health care, and their impression is that they’re not getting their money’s worth.”

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Preparing for Potential Reform: The Hospital View

by Rich Smith

Some proponents of national health care reform expect to pop the champagne corks any day now in celebration of getting a bill through Congress. Meanwhile, some administrators of hospitals and imaging departments expect to pop the lids off aspirin bottles so that they can begin nursing the headaches caused by undertaking the strategic repositioning of their organizations. Gerard A. Durney, MBA, senior vice president of surgical and ancillary services for the three-hospital Bon Secours Charity Health System in Suffern, New York, offers a tip of the hat to any enterprise that’s even able to get its collective mind around the impending changes, let alone map out a new course in response.

For starters, no one outside Congress has yet seen the finalized provisions of the reform legislation (the process of reconciling the Senate and House versions is taking place behind closed doors). “There are some critically important considerations we don’t yet know,” Durney says. “How many more people will be insured? To what degree will they be insured? What kind of copayments are they going to be responsible for—in other words, how much skin are they going to have in the game? Without knowing these details, strategic planning is very difficult.”

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Key Metrics for 2010: A Conversation With Marcia Flaherty, CEO, Riverside Radiology

by Cat Vasko

At RSNA 2009, analysis of key metrics was emphasized as a means for radiology practices to improve operations, augment quality, and reduce costs. In 2010’s health care environment of ever-declining reimbursement and renewed focus on outcomes, what are the key metrics for practices to use? ImagingBiz.com spoke with Marcia Flaherty, CEO of Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, for an inside look at the 40-site practice’s robust data mining and analytics.

ImagingBiz: How has Riverside used practice metrics to stay competitive in the past? What are some key metrics analyzed in 2009?

Flaherty: We internally develop metrics, benchmarks, and goals for each major business function, including IT, finance, billing, and clinical services and operations. Each year, these goals and benchmarks are reviewed and used to develop long-term and annual plans. On the clinical side, we have a peer-review process that spans all practice sites to review quality. We also review staffing and procedures by hour to determine physician resource allocation—this is further defined by subspecialty area, in some instances.

“We have developed standardized clinical guidelines and protocols across our sites of service. This is probably the area where we’re most sophisticated.”
—Marcia Flaherty, CEO
Riverside Radiology and Interventional Associates Inc, Riverside, Ohio

We measure turnaround time in about every fashion you can imagine; we have a standard that we want to make sure we hit at each of our locations, and we also want to make sure that we’ve staffed appropriately. We’ve grown, and we never seem to have a so-called typical year.

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