Noted Author Describes
"A Whole New Radiology"
By Curtis Kauffman-Pickelle

In the many strategic planning retreats that I have facilitated for radiology groups during the past couple of years, I have used as a basis for generating strategic and visionary thought a remarkable book whose author outlines a vision of our society's transformation—and the implications for medicine—to an age of heightened creativity and an increased reliance on right brain functions to understand and gain new respect for context. His thesis has many ramifications for radiology, especially in his delineation of the movement from mere "process" to adding value to the information that is generated. In my opinion, it is an understanding of this shift to a relationship model of interdependence between radiologist and referring physician that will ultimately determine the success or failure of tomorrow's practice.

On a whim, I contacted the best-selling author of "A Whole New Mind" to see if he would agree to an interview with me to share his thoughts on this concept as a direct message to radiology practices. To my delight he agreed and in the following Q&A, Daniel Pink gives all of us in this fascinating segment of medicine a glimpse of what will be expected of us if we are to be among the leaders, and, dare I say, survivors in this new era.

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Building an Emergency Responder Magnet Safety Program, Part II
By Nicole Pliner, MHSA, and
Frank Panzarella, MHSA, CHE

Last month, we presented a case for proactively training external emergency response personnel in magnet safety, and this month, in Part II, we outline how to develop such an education program for your community. The objectives of your program should be to:

• Provide basic MR education to emergency personnel

• Create an opportunity for individuals to ask questions in a confidential manner

• Affirm MR lessons learned through a written test and self-questionnaire

• Communicate critical information about your facility's layout and emergency quench protocols

Early in the process, MRI site managers should contact appropriate emergency leaders, including fire chiefs, police chiefs, and EMT liaisons to arrange times to educate emergency personnel on the dangers of ferrous materials near the magnet. Each presentation should be personalized to the group, but all should include a 25 minute PowerPoint.

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Washington Update:
Physicians 1, Imaging Centers, 0

Physicians received yet another reprieve when the Senate's final act before adjourning was to pass a broad tax and trade bill, 79-to-9, that contained the anticipated fix of the scheduled 5.1 percent cut in physician reimbursement.

The Access for Medical Imaging Coalition (AMIC), however, failed to obtain a moratorium on the cuts to imaging contained in the Deficit Reduction Act (DRA) of 2005, and many of the stringent new supervision and performance standards for imaging centers contained in the Medicare Physician Fee Schedule stand as originally proposed despite the efforts of lobbyists for the National Coalition for Quality Diagnostic Imaging Services (NCQDIS).

The bill that swept through the Senate at 2 AM Saturday morning was a combination of two bills passed the night before by the House: HR 6404 contained several controversial trade measures, and HR 6111 continued $38 billion in popular tax credits and forestalled, once again, the scheduled cut in physician reimbursement.

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The Shape of Things to Come:
A Glass Half Full

A spirited discussion featuring three key players in the freestanding outpatient imaging center market kicked off the 2006 Medical Imaging Symposium sponsored by health care law powerhouse McDermott, Will & Emery, held on November 28 at the Ritz Carlton in Chicago. A capacity crowd listened attentively as Howard G. Berger, MD, CEO, Primedix Health Systems Inc, Los Angeles, asserted that the DRA will have a positive overall effect on the imaging industry by forcing a consolidation, a trend Berger initiated last June with the merger of Los Angeles-based Radnet and Radiologix.

"The transaction that we just completed to merge two entities into what is now called Radnet Inc will begin a consolidation that is long overdue in this industry, " Berger said. "The industry is…hardly what anyone would call free enterprise." Berger said that consolidation is necessary to achieve the leverage in contracting to stem the downward spiral in reimbursement.

"In the long-run, the vision is to consolidate into networks and it will force all of us to be better operators and that will be good for the industry."

—Howard G. Berger, MD

Describing the reimbursement environment in California, Berger said his company, has developed a form of capitation that it markets to payors. "As a result, we have grown our own in-house radiology utilization management system," he said. "Since we take full risk for work that we do, we are also a gatekeeper primarily for advanced imaging, so all requests we get for PET scans are pre-approved by radiology and nursing staff."

Paul Viviano, CEO, Alliance Imaging, Inc, foresees great challenges ahead for the imaging industry. "It will be a time of shakeout and there will be a significant amount of consolidation that will go on," he predicted. "In addition to the obvious pricing pressure, there is a significant amount of utilization management pressure in the industry. Make no mistake, the next couple of years will be very tumultuous and the stronger companies that will survive this will emerge with a bright future."

On the upside, the DRA will benefit mobile PET imaging, Viviano said: "We believe the life span of mobile PET just got extended. Sixty percent is done on an outpatient basis."

Robert V. Baumgartner, CEO, Center for Diagnostic Imaging, Minneapolis, Minn, also sees a consolidation ahead. "The view we have of the future is that there will be less of us in the future and some of the capacity is going to go away" Baumgartner said. "We will be paid less per scan procedure and we are going to need to do more procedures."

Baumgartner predicted further price pressure from CMS and urged all stakeholders to get involved in the process. Sharing a conversation he had with former MedPAC member Nancy DeParle. Baumgartner asked DeParle how the government determines where to find savings. "'We cut, and if no one complains, we cut again,'" she told him

"Don't sit back," Baumgartner advised. "One Congressman told me if he gets two letters, he thinks it's a groundswell.'"

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Primedix Buys Radiologix

Positioned for Change:
The Agile Business

Change is part of the natural business cycle and those businesses that do not embrace and adapt to change risk becoming marginalized or, worse, obsolete. That was the message sent by Imaging Center Institute CEO Curtis Kauffman-Pickelle in The Incredible Shrinking Growth Market, a webinar sponsored by the Radiology Business Management Association, originally broadcast October 18, 2006. An integral element of such cycles is consolidation, in the form of mergers, acquisitions, divestiture, and strategic alliances. "Outpatient imaging is undergoing its consolidation period after unprecedented growth," he said.

Noting that the DRA is only one sign of the changing times, Kauffman-Pickelle urged owners and operators of outpatient imaging facilities to position themselves for the future by employing basic business blocking and tackling, and focusing on the fundamentals of revenue and cost management. "Be better than the guy down the street," he said. "Penetrate the noise level. Be more than mediocre."

Kauffman-Pickelle emphasized that imaging volume is projected to continue to grow moving forward, and even CMS calculated that diagnostic imaging as a share of national expenditures will also grow.

Kauffman-Pickelle offered the following strategies to help position your organization to prosper in the next business cycle:

• foster teamwork and communications
• focus on and empower your people
• focus on your customers
• be an agent for and embrace change
• live your brand and tell your story
• align your vision, mission, core values, and people
• be passionate about your business
• be willing to fight for the business when necessary
(don't take it for granted)
• run a tight and supremely professional ship, and
• be the kind of leader that your team will want to follow.

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Oncologic Imaging to
Log Staggering Growth
in Next Decade: Sg2

There are numbers and then there are numbers: oncologic imaging is forecast to grow 126 percent over the next decade, significantly outpacing the population-based forecast of 19 percent. That is according to a new report from Chicago-based consulting firm Sg2.

Expanding applications for advanced imaging and the emerging field of molecular medicine with its disease-target contrast agents and radiopharmaceuticals will help drive the growth in oncologic imaging. "As the technology develops, the traditional biopsy will increasingly be replaced by these highly specific noninvasive studies," wrote Christopher Farr, vice president of Imaging Intelligence, Sg2, Skokie, Ill, in a recent article in Imaging Economics.

Among the report's findings:

• Cone-beam CT will transform surgical imaging by providing volumetric data in special procedures rooms

• MR and PET images will be fused with CT for planning therapy

• Imaging will play an increasingly important role in monitoring treatment

• Increasing numbers of cancer survivors will be monitored over a lifetime

The author concluded with one important caveat: The increasing dependence of treatment on imaging is creating new workflow challenges and responsibilities for the radiology practices and departments that serve oncology.

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Oncologic Imaging: Growth Forecast for a Cancer Management Fundamental