Increasing CT Productivity: Good for Patients, Referring Physicians, and the Bottom Line

by Giles Boland, MD

CT has become indispensable tool for physicians to use in diagnosing and managing a vast array of medical conditions. The use of CT to aid triage of patients in emergency departments is now routine. Most patients with cancer are diagnosed and monitored by CT. Even many benign diseases are best diagnosed and monitored using CT. In short, referring physicians are demanding more and more CT as they continue to see increasing value from exams performed using newer and faster machines, combined with innovative protocols that expedite the diagnostic process.

The success of CT, however, has come with a price. Many radiology departments are struggling to keep up with the increasing demand, yet patients and referring physicians expect, and even demand, that requested scans be performed quickly. Any wait for appointments can delay an important diagnosis, and both patients and referring physicians may choose to be scanned elsewhere if they can obtain an earlier appointment. Meanwhile, CT has become highly profitable, and any loss of patient volume, either due to poor productivity or because of loss of market share, can have a significant negative effect on the organization’s bottom line. The net sum of all these pressures is that radiology managers are expected to provide rapid access to CT for referred patients and, in turn, increase CT capacity.

A frequent initial response to the demand for increased capacity is to purchase new equipment. While this ultimately may be necessary, invariably, many CT machines are not operating at optimal capacity. Too often, managers purchase additional CT equipment before full capacity has been realized, resulting in an unnecessary financial burden to many cash-strapped health care facilities. A more suitable approach would be to re-evaluate the existing workflow and operations critically to look for opportunities to increase capacity without resorting to purchasing new equipment. This makes financial sense, given the expense of the equipment, its requirements for additional space and staff, and the competition from other capital requests within health care facilities.

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Consumer-driven Health Care: Dealing With the Impact on the Physician Revenue Cycle

by Terri Fischer

The health care industry will be facing significant changes in the future, and a medical practice’s success is becoming increasingly linked to its revenue cycle. Reduced reimbursement from payors, along with changes in third-party reimbursement, has significantly affected how medical practices need to deal with the revenue cycle for their practices. Though consumer-driven health care is intended to provide a possible solution to rising health care costs, medical practices have already begun to feel the impact of this prominent trend.

The move toward consumer-driven health care is creating a world where patients must take more financial responsibility when it comes to managing their health, and this shift is forcing physicians to pay closer attention to the revenue cycle for their practices. As few as 20 years ago, when patients sought medical care, they understood that they were financially responsible for any services that were rendered. Insurance was only there to help reimburse them for their expenses. It was during these years that managed care developed nationally and became the standard reimbursement model, replacing the traditional model where patients carried much higher financial responsibility.

Under the managed care model, patients had little, if any, financial obligation relating to their health care. The return of financial responsibility to the patient under consumer-driven health care is a dramatic economic shift for medical practices and patients alike. This new emerging health care world—which includes catastrophic deductibles, increased coinsurance and copayment amounts, and gaps in coverage—is completely foreign to patients (consumers), as there exists an entire generation of health care consumers who have never had to bear the financial responsibility for their health care.

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Role of the Center Manager: Driving Productivity by Nurturing Cooperation

by Cat Vasko

The team at OGH Imaging LLC, Grand Coteau, La, faces a daunting task every day: living up to the expectations of both OGH’s hospital and physician investors while managing approximately 70 patient studies a day across eight modalities (MRI, 16-slice CT, ultrasound, DR, digital mammography, fluoroscopy, bone densitometry, and calcium scoring). Employing just six technologists—or seven, on the frequent occasions when David Rushing, center manager, steps in to help—OGH optimizes productivity, in a health care environment that’s increasingly focused on the bottom line, by maximizing staff cooperation, even while minimizing staffing.

Rushing explains that OGH Imaging was born out of a 2003 partnership between Opelousas General Health System, Opelousas, La, and four radiologists wishing to separate from the hospital and begin their own ambulatory service center. The partners jointly invested in OGH Imaging, and the new business opened its doors in December 2005.

“The hospital initially missed the opportunity to invest jointly with some of its physicians, and when they saw their error, they used OGH Imaging as a way to reach out to the radiologists and invest with them.”
— David Rushing, manager, OGH Imaging, Grand Coteau, La

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Palm Beach Radiology Institute: Digital Out of the Box

by George Wiley

At Palm Beach Radiology Institute, operated by Palm Beach Radiology and Imaging Associates (PBRIA), there is no film, there never has been film, and no one expects ever to see film. When the outpatient imaging center opened a year ago, it was already an all-digital environment, built from the ground up to accommodate a digital infrastructure and a paperless workflow.

The patient accesses the digital file from the RIS and verifies the information by signing a signature pad; the RIS routes the ordered exam to the modality; the patient is escorted to the exam room, where the images are acquired and sent to the PACS; when the study appears on the worklist, the radiologist interprets it and dictates the report, which is saved to the RIS; a remote transcriptionist transcribes in real time into the RIS; and within half an hour of the images hitting the PACS, reports are automatically faxed or emailed to the referrer from the RIS.

“I would estimate it is 30% to 40% more efficient than a nondigital environment.” —Scott Studdard, IT manager, Palm Beach Radiology Institute, North Palm Beach, Fla

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NightHawk Offers Model for QA

by George Wiley

It’s easy to let quality assurance (QA) slip into a lip-service category, but that is something that a nighttime stat-reading teleradiology service can’t afford to do—particularly if it is an industry leader like NightHawk Radiology Services. Dionne Watts, quality-assurance supervisor, says “QA for teleradiology is important because the client facility doesn’t know our radiologists. They like to see how good we are. They don’t personally see us on a day-to-day basis, so there is a trust factor that takes a lot longer to build. QA is a part of that.”

Watts, an Australian who now works at NightHawk headquarters in Coeur d’Alene, Idaho, says that NightHawk put its QA program together eclectically, using Joint Commission requirements, ACR guidelines, and HIPAA regulations to frame its QA structure. NightHawk went further, though. The company researched QA at other big health care institutions and then added some ingenuity of its own to devise a program that met its special needs as a teleradiology provider. The result is a QA program that could be a model for other health care providers—and in fact, it often is. Watts calls it a “robust, reliable, and educational program.”

NightHawk’s QA program isn’t simple. It can be quite complicated, but it’s built on a simple framework: image interpretation errors or omissions are reported, reviewed, and studied for prevention next time.

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Radiologist, Find Your Voice

by Curtis Kauffman-Pickelle

In a major front-page story, “The High Cost of Precision,” in its Sunday, September 7, 2008 edition, the Los Angeles Times once again focused on the negative side of CT technology. Its opening statement positioned its argument by saying, “CT scans produce detailed views of internal organs, but they expose patients to significant radiation.” The tone of the piece was made even clearer with two subsequent headlines: “Revolutionary scans come with a risk,” and the real kicker, “CT scans can be good for doctors.” Hint: Doctors make a ton of money from these scans, most of which are unnecessary.

There is, of course, nothing new about the fact that the media love to write stories about how doctors are making money with sophisticated imaging technologies. Both the New York Times and, now, the Los Angeles Times have focused in the past year on articles that underscore the outliers in the profession who are greedy and unscrupulous. As in any profession, these types of people are unfortunately part of the fabric, and it has been this way since the beginning of time. Examples are easily found, and they make for good newspaper copy.

In this particular case, the author of the article focuses on one aspect and byproduct of one of the most remarkable technologies ever invented. Without comparing the obvious risks associated, say, with surgeries that have been replaced by CT, the author outlines in great detail the number of CTs performed in a year; the fact that at 81 CT scanners per million people, the United States has almost three times the average for the rest of the industrialized world; and the cumulative radiation dose of these scans (frightening levels of millisieverts).

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The Dynamics of Reimbursement and High-quality Care

by Kris Kyes

Access to high-quality patient care is a cornerstone of customer-focused service delivery, Michael A. Silver, PhD, says. In turn, that goal is supported by technology that enhances performance and allows the imaging provider to do more with less. Part of making less go further is maximizing reimbursement through better management, he adds, ensuring that the work performed yields as much as it should. Silver, vice president of Sg2 (a health care research, consulting, and education company based in Skokie, Ill), presented The Outpatient Imaging Market: 2008 Market Update at Beyond™, the Third Annual GE Healthcare Outpatient Imaging Center Conference, in Washington, DC, on July 24, 2008.

In the current environment, health care policy decisions are driven less by clinical considerations and more by political and economic factors, especially as the payment system for health care in the United States becomes less workable, Silver observes. Payors, regulators, and some lawmakers are attempting to resolve distinct issues, rather than address underlying causes, and too few politicians understand the issues. With the subprime mortgage crisis negatively affecting access to capital and the cost of credit, it is little wonder, Silver says, that market pressures are being heavily felt by all imaging providers, yet rising consumer expectations demand attention to performance and customer service.

What is required, Silver advises, is a keen attention to margin and sophisticated management expertise.

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The Next Wave: Compliance With Medicare IDTF Standards Requires Ongoing Diligence

by Scott Garrett

To say that the health care regulatory environment has been active over the past two years would be an understatement. The focus of this article is Medicare: the primary payor for health care services in this country and, often, the standard by which other payors establish their payment rules. Revisions to Medicare regulations often foretell what can be expected from other payors.

Changes to Medicare regulations in the past two years have been especially challenging for IDTFs. While basic rules for IDTFs were established by CMS in 2000, consistent enforcement of these rules did not begin in earnest until 2005. With the implementation of certain aspects of the DRA and the IDTF standards in 2007, IDTFs have experienced an almost exponential growth in regulatory pressures. In order to succeed, IDTF providers must actively seek to stay current in the ever-changing Medicare regulatory environment.

In July 2008, CMS issued proposed changes to the IDTF standards1 (proposed rules) that, if finalized as presented, will change the business environment for all nonhospital-based outpatient imaging providers. Couple this with impending accreditation and physician/technologist qualification requirements under the Medicare Improvements for Patients and Providers Act² enacted in July 2008, and the stage is set for significant regulatory changes in the imaging industry. While other regulatory pressures exist at federal and state levels, Medicare may be the most significant regulatory force that diagnostic imaging faces in today’s health care environment.

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