Goodbye to Adolescence
By Curtis Kauffman-Pickelle

Curtis Kauffman-Pickelle

I’m sure you remember the time very well. You grew at great clips and with a seeming lack of difficulty, you stayed nimble no matter how much you ate, you saw nothing but opportunity in front of you, and you laughed in the face of those who told you that these were your golden years. Soon the time would pass and it would be necessary to “settle down.”

Then one day you awake to the reality that the days have been since passed when you could make no mistake that time couldn’t heal. Time now seemed to move more quickly, and you reached a point in which the rules of the world would require you to be more responsible and, yes, predictable.

Discovering that you have finally achieved maturity is a mixed blessing, indeed. One wistfully recalls that long-ago ability to move quickly and grow without many impediments. Yet maturity also brings with it certain benefits that when managed correctly can bear different and longer-lasting rewards

Such is the case with the outpatient imaging profession and the world of diagnostic imaging in general.

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Legislative Report:
Letter-Trafficking and Self-Referral in Massachusetts
By Edward J. Brennan, Jr, JD, and John Dubrow, MD

Edward J. Brennan, Jr, JD

John Dubrow, MD

As in many states, Massachusetts policy makers are examining the impact that ambulatory surgical centers and medical diagnostic imaging services, particularly physician owned, are having on the health care delivery system. Last year, the Massachusetts Legislature created a special study commission to examine these health services and their impact on access and the cost of health care. Part of the commission’s work focused on the issue of over-utilization of imaging services. The commission issued its report on June 30, 2007.

The commission consisted of legislators, state health officials, and representatives of hospitals, insurers, ambulatory surgical centers, and physicians, including a representative of the Massachusetts Radiological Society.

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Annette Marinaccio, CPA

One would think a metropolitan radiology practice that is 100% dependant on the outpatient market for all income would be at a competitive disadvantage in this post-DRA marketplace. But, if the practice in question were Nassau Radiologic Group, one would be dead wrong.

The 40-person practice, founded in 1927 and based in western/northern Nassau County, is currently considering multiple acquisitions and has embarked on a new wave of investment in bolstering its infrastructure and digitizing technology. ImagingBiz.com discussed this and other topics with practice chief executive Annette Marinaccio, CPA, who has directed business operations for Nassau since 1988. Nassau County is a suburban county in the New York Metropolitan Area east of New York City on what is referred to as Long Island.

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Craig Anderson, Sr

After watching outpatient-imaging centers siphon away their often-lucrative outpatient imaging services, hospitals in growing numbers are moving aggressively into surrounding communities to establish outpatient imaging center beachheads. The trend began heating up five years ago, according to Craig Anderson, Sr, founder of Charis Healthcare LLC, Hudson, Ohio, a company that specializes in helping hospitals and physicians accelerate services in the non-hospital outpatient environment.

“Hospitals are realizing that a large majority of the revenue is leaving the hospital campus—or at least leaving the walls of the hospital—for a couple of reasons,” Anderson reported. “Physicians are adopting and acquiring more technology that allows them to deliver services in their offices; entrepreneurs are coming into the marketplace and putting up services that are taking away business from the hospital; and patients really are demanding a more customer-focused, friendlier, easy-to-get-to set of delivery systems.”

“In competitive markets this is becoming a battleground between hospitals and hospital systems to put up significant, comprehensive ambulatory care delivery systems. So the market is changing dramatically.”

— Craig Anderson, Sr,
Charis Healthcare

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Marketing Best Practices for Imaging Centers in the post-DRA Era
By Frank J. Lexa, MD, MBA

Marketing and branding should always be part of your competitive strategy in medical services. In comparatively easy times, many radiology practices were able to do well with little or in some cases even no organized efforts to address marketing issues. However, now the pressures on most practices have grown significantly. The strong challenges to diagnostic imaging in the wake of the DRA and other budget cuts combined with rising competition from self-referring clinicians and other non-traditional imaging enterprises have brought us into a new era. We will need to focus harder on strategies and tactics that will improve our ability to compete in a tougher environment.

More than ever, we will need to focus on the core issues of how we apply marketing principles to the diagnostic imaging practice.

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PACS Administrator
Success Indicators
By Maryann Tateosian, RT (R) MM and Alan Schweitzer, MEE

What does it take to be a successful PACS administrator? As we work with clients across the country, we are commonly asked this question. The answer lies in both understanding the multiple roles this person is asked to play and the resources that will be available to support him or her.

PACS administrators are asked to play many roles. Yes, a key role is daily monitoring of the PACS, integrated systems, and interfaces, as well as daily monitoring of data integrity. PACS administrators must essentially ensure that the radiology workflow—from examination acquisition and reporting through enterprise image access and viewing—runs smoothly. He/she must also ensure that the data integrity is maintained. Duties such as developing departmental worklists, detection and reporting of radiology examinations not archived to PACS, repairing examinations with incorrect status in PACS, and correcting misidentified patient examinations are all responsibilities of the PACS administrator. However, the role of the PACS administrator goes well beyond that of day-to-day system maintenance.

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Michael Silver, PhD

Imaging will grow a respectable but relatively sedate 12% to 14% over the next 10 years, and the vast majority of that growth will occur un the outpatient sector, predicted Michael Silver, PhD, vice president, Sg2, Skokie, Ill, at the 2nd Annual GE Healthcare Outpatient Imaging Center Conference in Washington, a rate roughly one third of the imaging growth rate of the previous decade. Silver identified five major growth areas over the coming decade, including cardiovascular imaging, cancer-related imaging, and neurological imaging.

Radiology could see more of what Silver calls broad, “Excel-sheet” cuts to federal health care programs, like those wrought by the Deficit Reduction Act of 2005. The intention of the federal government in enacting the Deficit Reduction Act, Silver maintained, was to decrease the growth rate for imaging and to force a payment volume correction. In effecting that strategy, the government targeted the entrepreneurial and opportunistic segment of the market, which is much more sensitive to growth and payment levels than the hospital market.

“They don’t look at imaging in a granular manner at all, it’s a line on the Excel spread sheet. In general, any rapid growth is growth that should be inhibited: They want predictable growth.”

—Michael Silver, PhD, Sg2

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Radia Homogenizes Client Base with Homegrown Worklist

Jack M. Jones

Jeffrey Robinson, MD

The PACS has come a long way since its inception, enabling communications among all imaging stakeholders in a hospital or health system. But what is the large radiology practice to do that works in a heterogeneous environment, with multiple information and dictation systems, and a centralized reading model?

Radia, a 75-physician radiology and vascular practice based in Everett, Wash, found itself in just such a predicament. Since launching its teleradiology operation—teleRadia—in 1998, the service has evolved from a way to provide nighttime emergency reads for client hospitals to a thriving service line that provides nighttime coverage, subspecialty reads, and supplemental reading for more than 30 hospitals, clinics, and radiology practices, all of which have their own information systems.

The practice’s information system — devised under the guidance of CIO Jack M. Jones and teleRadia medical director Jeffrey Robinson, MD — works remarkably well considering the number of PACS and information systems involved. But in order to broaden its service and meet demand in its marketplace, Radia knew it needed to exact more efficiency from both its information technology and its radiologists.

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RBMA DRA Mini-Survey:
Most Practices Expect to Cut Radiologist Pay

A significant percentage of practice managers responding to a survey from the Radiology Business Management Association said radiologists would take a pay cut in 2007 if the DRA is not rolled back. The survey, DRA: How Is it Impacting Your Practice, conducted by LarsonAllen, Minneapolis, Minn, received 83 responses, 83.1% of which reported billing both technical and professional components.

Nearly 90% (62) of those respondents that bill the technical or global component (69) said they expect to experience reductions in the technical or global component due to the HOPPS cap from payers other than Medicare. But at the time the survey was taken, respondents were predominantly uncertain of payer intentions when presented with a list of 12 payers. Of all payers, United Healthcare appeared to have moved most aggressively to implement reductions, with 24.6% of respondents reporting that United had implemented the cuts and another 16.9% saying it will implement cuts in their respective area.

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Health care has become a serious problem. Health care costs are threatening the competitiveness of U.S. firms, and uneven health care quality is threatening the welfare of U.S. citizens. Last decade’s solution, managed care, is clearly a bust.

What to do?

Consumer-driven health care (CDHC) is the new solution, one that responds to consumers’ desire for choice with highly-differentiated health plans, control of expenditures, and helpful information. It will be implemented in the next presidential administration through tax reform that enables individuals, and not only corporations, to use tax-protected funds to buy health insurance and care.

Advocates hope that CDHC will create a cheaper, better health care system.

How will it accomplish these changes and what do they mean for imaging leaders?

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