Imaging's Unsung Heroes
By Curtis Kauffman-Pickelle

I have the best job in the world. In the past month alone, I visited 10 outpatient imaging facilities as part my ongoing relationships with clients all across the country. It is an incredible privilege for me to see so many different operations throughout the year and to be involved with their leadership and development strategies. This month, I witnessed one successful grand opening, one magnet quench, several site tours, strategic planning sessions, and considerable more.

On one recent visit I had one of those “ah-ha” moments and was surprised by the fact that it had not necessarily occurred to me in this same way many years ago. Nevertheless, what is probably obvious to anyone in this business is that the true unsung heroes of our outpatient radiology world are the center managers—those people probably have the hardest job of all. They are in the line of fire and accountable for each and every detail of their imaging center. They most often are taken for granted in the big picture discussions about the global view of the practice and its market position and mission.

You need the toilet paper changed in the rest room? Call the center manager. Got an angry patient that needs to vent? Call the center manager. Dictation is backed up and the lead just quit? Call the center manager. A last minute marketing lunch is scheduled with a big referrer and no radiologists are available? You’ve got it: the center manager is called on to pinch hit for the docs.

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Be Mindful of Stark in CCTA Alliance
By Thomas Greeson, JD

Numerous radiology groups are currently discussing arrangements whereby cardiologists and the radiologists would essentially split the responsibilities for reading coronary CT angiography (“CCTA”) studies. Most commonly, as proposed, the cardiologists would read and generate a signed interpretation report, but limited to the cardiac portion of the CCTA scan. The radiologists would read and generate a signed interpretation report for the non-cardiac portions of the CCTA studies. The cardiologists would then bill for all of the professional services and compensate the radiologist for its portion of the services pursuant to a professional services agreement.

In an effort to protect the parties from potential scrutiny by the local Medicare carrier, some consultants have recommended sending a letter to the local Medicare carrier requesting clarification or approval of the proposed shared reading arrangement. While such contacts with the medical director for approval is prudent and—assuming approval is granted—it could provide the parties with some measure of protection from regulatory scrutiny, such approval does not address or provide any degree of protection to the parties with respect to potential liability under the federal Stark law.

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Keep Your Friends Close
and Your Enemies Closer
By Nicole Pliner, MHSA

With the fierce competition we are confronting in imaging, this advice has never been more applicable. How well do you know your competition? In a previous column, I discussed the importance of efficient operations for survival. However, internal operational efficiency is only half the battle. Growing and maintaining a referral base is the other half. While internally you must focus on delivering efficient, high quality care, externally you must focus on positioning yourself in the market and launching a strategic marketing effort.

So where do you begin? A strategic marketing plan is a daunting task. The first step is gaining an understanding of your position in the marketplace. At the core of this understanding is detailed knowledge of the competition. As in chess, knowing your competitors and anticipating their every move, gives you an edge.

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CCTA: Payors Tune In

While radiologists and cardiologists wrangle over how many cardiac CTAs a physician must read before he or she is proficient, some payors are already planning for the rational introduction of this powerful new tool. According to a report in the Payor Watch section of the October issue of Imaging Economics, National Imaging Associates Inc (NIA), Rancho Cordova, Calif, a radiology benefits manager and a division of Magellan Health Services, Avon, Conn, will launch a pilot program this month to evaluate the diagnostic use of 64-slice coronary CT angiography (CCTA). The endgame, according to Thomas G. Dehn, MD, FACR, executive vice president and chief medical officer at NIA, will be to discover whether it is more efficient to begin a coronary artery disease assessment with a traditional nuclear study, such as stress myocardial perfusion imaging, or with CCTA.

In addition to comparing the efficiency of CCTA, the pilot program includes following up with patients after the procedure. Patients with insignificant to moderate CAD will receive cardiac counseling.

“It’s believed by some that the resources for doing good cardiac counseling are not available in the community, and we’re going to ask some of those questions, questions that are related to the socio aspects of coronary artery disease and lifestyle counseling. Our postulate is that if the reimbursement rates were better for cognitive services, cardiac counseling would probably be better. But we don’t know. We’re going to find out.”

—Thomas Dehn, MD, FACR

The following plans are scheduled to participate in the NIA pilot program: Blue Cross/Blue Shield of Idaho, Blue Cross/Blue Shield of Hawaii, Health New England, Independent Health (New York), and Blue Shield/Blue Cross of Western New York. NIA offered the program to its insurance clients across the nation.

links >>

www.imagingeconomics.com

www.imvinfo.com

Waiting for the Word

Congress recessed for the elections without passing a health care bill, confirming the suspicion that a fix for radiology reimbursement is likely to go down—or not—to the wire. Much hinges on a hoped-for legislative fix of the DRA cuts in the radiology community as well as the 5.1% reduction in the conversion factor for the MPFS for all of the physician community. If nothing changes, a report prepared for the National Coalition for Quality Diagnostic Imaging by Washington law firm Arent Fox suggests that radiology will have the following to contend with:

The conversion factor will drop from $37.8975 to $35.9647, and possibly even lower

Medicare will impose a 25% multiple procedure reduction for certain families of CT, CTA, MR, MRA, and Ultrasound

The technical component of outpatient imaging paid under the MPFS will be capped at the Hospital Outpatient Prospective Payment rate

Changes to the practice expense methodology, anticipated to render an average 4% reduction for overall reimbursement to IDTFs by 2010

In sum, these cuts present a sobering outlook for 2007 and beyond, not just for outpatient imaging, but also for all of medicine. According to a report prepared for the National Coalition for Quality Diagnostic Imaging by Washington law firm Arent Fox, independent diagnostic facilities will face a 6 percent cut and a 28 percent cut in reimbursement for a CT scan of the abdomen and pelvis performed in the same session, respectively, in CY 2007. The reimbursement outlook for CPT codes 70553 and 74183, MRI Brain w/o and w/dye and MRI abdomen w/o and w/dye, is particularly dire: both will drop 48% to the HOPPS capped rate, from $995.19 and $980.41 to $513.48.

click to enlarge chart

Courtesy of NCQDIS

NCQDIS is preparing comments on the proposed MPFS to be submitted to CMS. Join or lend your support to the NCQDIS.

Breast MRI Hurdles

Imaging centers that provide women’s imaging services need to consider adding breast MRI, but they are well-advised to proceed strategically, according to a presentation at the recent Breast Imaging Conference in Las Vegas by Laurie L. Fajardo, MD, MBA, professor and chair, department of radiology, the University of Iowa, Iowa City. There are many hurdles to clear, clinically, economically, and operationally, beginning with workflow. “Workflow efficiencies for breast MR are lagging behind those for body, head & neck, and abdominal MR,” advises Laurie L. Fajardo, MD, MBA

Dedicated, proprietary workstations and hence the ability to compare other studies can be awkward. There are currently no clear care pathways defined, so your practice will need to establish when to use a bilateral instead of unilateral approach and how to follow patients. Additionally, reimbursement is erratic for some of the most useful indications for breast MRI, such as assessing response to neoadjuvant chemotherapy. Because there will be times that you will want to do a breast MR and it will not be covered, patients need to know that they will get a bill. For practices planning to add breast MRI, Fajardo offered these additional suggestions:

Define indications and estimate volumes

Investigate local Medicare carrier and third-party payor coverage policies

Consider the implications of the DRA for freestanding sites

When considering technology, plan for future applications such as MR spectroscopy

Technology upgrades entail coil upgrades, so negotiate accordingly

Use mammography technologists to help position the patient

Because there are more gray areas in breast MRI than any other area of MR, consider joint reading initially (mammographer and MR subspecialist)

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Breast MRI: Adding It to a Practice

Breast MRI: What It Takes