Ten Trends, Five Years: Predictions for Outpatient Imaging

by M. Shane Foreman

While long-term forecasts are always subject to error in a changing climate, today’s market trends can provide strong, reliable indications of what to expect in the future. For outpatient imaging over the coming five years, ten ongoing trends, in particular, can be predicted based on the changes being seen in imaging now.

Trend one: Demand for outpatient imaging, and the resulting procedural volumes, will continue to increase.

Medicare outpatient imaging has increased for all modalities, exhibiting growth of more than 60% in some areas. CT and MRI volume growth have been exceptional, increasing at a rate of about 200% over the past 10 years. Economic factors have played a central role in imaging growth, with radiologists hoping to create a new revenue stream in the technical component, specialists attempting to augment their practices, and entrepreneurs trying to secure a historically strong return on investment.

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The Role of CCTA in Primary Care

by Laurie Fischer

Primary care physicians are increasingly referring patients for coronary CT angiography (CCTA) to provide accurate diagnosis of coronary artery disease (CAD) and earlier disease management for their patients. Most practitioners recognize the benefits of CCTA for those who are at risk of coronary disease, as well as for patients who exhibit related symptoms. Still, clearing the way for these patients to take advantage of the advancing technology has been fraught with roadblocks.

Although the technology has been available for years, it wasn’t until recently that CCTA was confirmed as providing more accurate information on the progression of coronary CAD than that provided by other diagnostic cardiology tests. In fact, a report in the American Journal of Cardiology for March 15, 2008, found that 64-slice CCTA has superior sensitivity and specificity in diagnosing obstructive CAD, compared with stress testing. “CCTA blew the doors off stress testing,” David Dowe, MD, a radiologist at Atlantic Medical Imaging in Galloway, NJ, explains. “In the last month, we now have medical justification to provide to the insurance companies. CCTA should be the first-line test when examining patients expected to have CAD,” he emphasizes.

Dowe reports that 60% of his radiology department’s referrals for CCTA are from primary care physicians. About 10% come from cardiologists, while the remaining referrals are from hospitalists, nurse practitioners, and self-referrals. He estimated that in 2007, his department did 2,000 to 3,000 CCTAs, and he expects a growing demand for the diagnostic test. “It is an everyday exam,” he says. “We are further along down the road; it is becoming mainstream.”

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To Read or Not to Read

by Curtis Kauffman-Pickelle

As Shakespeare’s famous Prince of Denmark did, many radiologists I know struggle with choosing between two mutually exclusive paths to fulfillment. In Hamlet’s case, the idea of honorable revenge was countered by fantasies of ending it all. While not as draconian, the choice for radiologists is nevertheless gut wrenching.

Should you continue to suffer the slings and arrows of life’s outrageous fortune, which brought you the so-called opportunity to read imaging studies conducted increasingly by other specialists with their own newly purchased equipment?

Instead, do you stand on principle and ignore the path that leads inexorably to (at least short-term) financial security? It’s a tough choice. Maybe you have kids in college with high tuition bills. Maybe you still have your own student loans to repay. Maybe you have simply become locked into a lifestyle that requires boatloads of cash to keep it going. In any case, walking away from lucrative reading contracts with doctors at the top of the self-referral food chain sounds easier than it might prove to be for many radiologists who would otherwise denounce the practice.

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Chris Winkle: Taking MedQuest In-House

by Cheryl Proval

Last August, the news that Novant Health, Inc, Winston-Salem, NC, had offered $45 million (with an additional performance-based contingency of $35 million and the assumption of all outstanding debt) for Alpharetta, Ga-based MedQuest set the outpatient imaging world abuzz. The deal, which closed in November, represented what many considered a premium price for MedQuest’s 92 outpatient imaging centers and gave Novant a huge and immediate presence in outpatient imaging in the Southeast.

Two years earlier and fresh from an ordeal in which he brought long-term care provider Mariner Health Care, Atlanta, out of Chapter 11 and negotiated the successful sale of that company, Chris Winkle had come on as CEO to turn around MedQuest. The sale to Novant behind him and the Deficit Reduction Act (DRA) notwithstanding, Winkle is looking forward to enjoying life under the Novant umbrella.

“The Mariner turnaround was like living in dog years: the outcome was great, but it wasn’t much fun on a day-to-day basis. Having seen the good, the bad, and the ugly in health care, it’s really gratifying to have a solid organization such as Novant as our owner. You can see the big picture. They are the kind of organization that when they talk about a 10-year vision, you know they are going to live it and fulfill it.”
— Chris Winkle, CEO, MedQuest

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2008 Update on Non-hospital-based Outpatient Medicare Reimbursement

by Kris Kyes

As part of GE Healthcare’s commitment to ongoing monitoring of the reimbursement situation, GE presented a Webcast on this topic on May 7, 2008. Called the 2008 Reimbursement Environment for OICs, the program was presented by Michael Becker, general manager, reimbursement, and John Schaeffler, manager, federal government relations, both of GE Healthcare.

The hour-long Webcast covered 2008’s changes in outpatient imaging reimbursement; current threats to reimbursement, along with positive developments for some imaging applications; the Economic Stimulus Act’s benefits for imaging providers; and GE’s important work in imaging advocacy among payors, lawmakers, regulatory agencies, the medical community, and the public. (These reimbursement topics will be covered in greater depth at the 3rd Annual GE Healthcare Outpatient Imaging Center Conference in Washington, DC, July 23-25. Executives can access conference information and register at http://www.gehealthcare.com/registration.)

The presenters noted that imaging has become a target for spending cuts because of its own success, with the highest rate of growth in Medicare services per beneficiary, which it has sustained over the past several years. Because overutilization of imaging is often cited as a driver of this growth, payors are attempting to slow growth through aggressive measures.

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Proper Coding Delivers Big Results

by Dan L. Hiebert

Correct procedure coding is a primary, and pivotal, activity among providers and payors alike. Undercoded claims leave money on the table, while overcoded claims leave the practice exposed to financial risks, including potential accusations of fraud. If a practice spends too much time on coding, reporting, reviewing, scheduling, code approval, and amending reports, the practice will suffer as turnaround times increase and staffing expenses soar.

What if you knew, though, that more than 99% of your practice’s claims were correctly coded? Would your practice bring in more money? Would you sleep better at night, knowing that you were not at risk for repayment and/or fraud accusations? How can correct coding be achieved while improving, not harming your practice or patient care? All of these questions provide a framework for establishing a simple, yet necessary, system for ongoing audit and review of your coding practices.

About a year ago, I introduced myself to ImagingBiz.com’s readers as Inland Imaging’s new chief reimbursement officer (CRO). As the company’s CRO, I am responsible for maximizing the revenue delivery of our organization by implementing and managing billing and contract practices that accelerate and enhance billing services.

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CCTA: The Road to Acceptance

by Steve Smith

The advancement of imaging technology is invariably followed by a host of related challenges. Many of these challenges are questions raised by payors and answered by various medical associations in an effort to ensure a seamless transition from research and development to practical use. Coronary CT angiography (CCTA) has followed this well-worn path.

As one may expect, physicians were pleased with CCTA as another arrow in their treatment quivers, while payors were concerned about overutilization, specifically the use of CCTA as a screening tool for patients without symptoms or risk, or at low risk, for coronary-artery disease (CAD).

Appropriately, some medical organizations, including the American College of Cardiology, the ACR, and the Society of Cardiovascular Computed Tomography, have developed appropriateness criteria for CCTA that establish guidelines for proper use of this technology.

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Advanced Visualization: A Do-it-yourself Approach

by George Wiley

With three-dimensional and other advanced visualization tools being used for a greater share of CT and other imaging studies, it is more important than ever for radiologists to have access to postprocessing software and equipment at the point of interpretation.

It is equally important for radiologists to develop and keep up their skills in using these tools. This means that hospitals and radiology practices must decide which kinds of advanced visualization tools they will put in place and where and how they will deploy them. Will they opt for enterprise-wide, single-vendor solutions, or will they choose best-of-breed approaches that might limit image distribution in favor of the ability of one vendor’s tool to perform a task particularly well?

At Albert Einstein Medical Center (AEMC) in Philadelphia, both approaches are used. Radiologists have access to advanced visualization tools embedded in their PACS software (Synapse from FUJIFILM) as well as a thin-client advanced visualization tool that has been interfaced with the PACS, tools powerful enough to handle the majority of the radiologist’s post processing needs. For other studies, like virtual colonoscopies, the hospital uses specialized post-processing tools.

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