The Outpatient Imaging Forecast Is Mixed, but Growth Is Ensured

by Steve Smith

In November 13, 2008, GE Healthcare, Waukesha, Wis, hosted a webinar entitled Interpreting the Future of Medical Imaging. Offering insights into the future of the field were Bob Maier, president and CEO, and Brian Baker, senior vice president, Regents Health Resources, Brentwood, Tenn.

Imaging will continue to grow, although the path to prosperity may include several obstacles, according to Maier, who adds that the playing field is leveling for all imaging providers. Among the key points presented at the outset were that all imaging operators will require accreditation by 2011, that both provider-based reimbursement and the DRA lesser-of fee schedule will grow by 3% in 2009, and that there will be an increasing focus on quality.

Maier shares the view of Daniel R. Levinson, inspector general, DHHS, who believes that imaging growth in the next five years will be fueled by research and its application to existing technology.

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Top 10 Control Items for Managing Practice Financials

by Steve Smith

You have, no doubt, heard the story about the quiet, loyal employee with many years of service to the business who one day sends his boss a postcard from Rio de Janiero, saying that he’s not coming back. Then the owner discovers that a large amount from accounts receivable is missing.

In a situation such as that, the chances are good that the basic control, reporting, and accountability standards that are in place in almost every other business were not in place in that medical imaging office. As a result, there is a greater potential for embezzlement and theft.

Lori Laubach, CPA, is a health care partner at Moss-Adams, LLP, an accounting firm headquartered in Seattle. At the Fall Educational Conference of the RBMA in San Antonio, Laubach presented Top 10 Control Items to Score and Manage Your Practice, during which she offered basic guidelines for holding the cash-management departments accountable in order to avoid fraud.

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Patient Surveys Guide Competitive Strategies

by Kris Kyes

Asking customers what they need is one of the best ways of retaining their business, in the experience of Frank J. Lexa, MD, MBA. Lexa is clinical professor of radiology, University of Pennsylvania Medical Center, Philadelphia; professor and Asia regional manager of The Global Consulting Practicum and adjunct professor, department of marketing, The Wharton School, Philadelphia; and adjunct professor of biotechnology, Instituto de Empresa, Madrid, Spain.

He presented Service and Quality Methodologies: How to Find Out What Your Patients Really Want at the 23rd Annual Economics of Diagnostic Imaging 2008: National Symposium in Arlington, Va, on October 25. There is, he says, no other $2 trillion industry on earth that exhibits the level of stakeholder dissatisfaction seen for health care today.

Part of the problem, he adds, is that there are so many stakeholders, several with interests and incentives leading them in different directions. The customers of imaging facilities, for example, include nearly everyone, at some point: hospital executives, joint-venture partners, private and public payors, regulators, quality/service aggregators, and referring physicians and their office personnel—in addition to patients and their significant others, friends, and relatives.

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Summit Radiology CEO Mark Schaefer: The Role of IT in Building the Practice

by Cheryl Proval

The story of Summit Radiology is in some respects archetypal: the story of the modern radiology practice. Responding to changes in the health care regulatory and reimbursement environment in the late 1960s, staff radiologists at St Joseph and Lutheran Hospitals in Fort Wayne, Ind, formed Allen County Radiology Associates, Inc, and CFB Radiology, Inc. In 1995, those two groups merged to form Summit Radiology, PC, again in response to the challenges of the health care marketplace. Currently a 39-radiologist group, Summit services 13 area hospitals and 14 outpatient imaging facilities (none are owned by the group). Summit owns and operates a dedicated interventional-radiology outpatient clinic. All sites collectively generate more than 700,000 procedures annually. The glue that holds the workflow together is a practice-owned PACS, RIS, and voice-recognition system, maintained by an internal IT department. Mark Schaefer, who has been associated with the practice in various capacities since 1987, became the CEO in June 2007. He agreed to discuss the role of IT in building the practice with ImagingBiz.com

ImagingBiz.com: At what point did the practice see the value of IT?

Schaefer: We began seeing value in 1999–2000 with our own PACS, which consisted of several stand-alone RadWorks workstations and one PACS at a major hospital. In 2005, we upgraded our PACS to eMed to handle increasing volumes from some of our contracts that did not have PACS (but were digital), and to give us a platform to consolidate some of our after-hours work. Now, we are replacing the eMed system with FUJIFILM Synapse, which we feel will allow us to go to the next level with our practice.

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Revised Anti-markup Rule: CMS Gets Creative

by Jennifer (Beech) Lohse, Esq

On November 19, 2008, CMS issued the Medicare Physician Fee Schedule (MPFS) for calendar year 2009. Consistent with the CMS trend of introducing substantive regulatory changes in payment rules, the MPFS Rule contained a number of significant revisions, including the closely watched anti-markup provisions applicable to diagnostic services other than clinical diagnostic laboratory tests (the anti-markup rule). In the 2008 MPFS final rule, CMS finalized significant revisions to the anti-markup rule, including extending the rule to purchased interpretations. CMS, however, subsequently delayed the effective date for the majority of diagnostic services in response to numerous requests for clarification by affected physicians and suppliers (anatomical pathology labs were still subject to the final rule as promulgated). The effective date of the revised anti-markup rule is January 1, 2009.

The anti-markup payment limitation has been in effect for many years, but it was difficult, at times, to determine when the physician who ordered and billed for the services (the billing physician) had actually purchased a test. In the proposed rule for the 2009 MPFS, CMS attempted to provide clarification and proposed a number of alternatives for determining whether the payment limitation of anti-markup rule would apply to the technical component and/or the professional component of diagnostic services. CMS had moved away from the concept of purchased tests, purchased interpretations, and outside suppliers for the purposes of the anti-markup rule, and instead concentrated on the relationship between the physician who was performing the services and the billing physician.

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Bread Lines and Cab Lines

by Curtis Kauffman-Pickelle

I’ll admit it. The constant drumbeat of depressing news in the business and popular press about the downturn in the world economy had me spooked as I traveled to the RSNA last week. Day after day, the relentless narrative of job losses, housing foreclosures, lost retirement wealth, and mind-boggling federal bailouts prepared me for the worst. I have been attending this mega event for more than 20 years, and I have seen the effects of economic upheaval on our profession in the past, but I was certain that this one would be, well, nothing but doom and gloom. I prepared myself to do a bad-news wrap-up of one of the world’s largest association-sponsored trade events.

As the taxi approached the entrance to McCormick Place, I half expected to see bread lines and guys in business suits selling apples on the corner instead of CT scanners inside the exhibit hall. Because of the press reports, I certainly expected to see depressed faces with grim expressions, in some type of third-world experience.

Imagine my surprise when I discovered that the RSNA was, in fact, much as it had been in past years. There was a bustling crowd, along with huge exhibits, an opening session packed with attendees, and professional representatives determined to conduct business. It appears that health care is, in fact, weathering this economic storm better than most segments of the economy.

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Bolstering the Team: Outsourcing Final Interpretations and Billing

by Cat Vasko

For Kalvinder Sumra, MD, medical director at Pembina County Memorial Hospital, Cavalier, ND, the challenge has never been keeping his radiologists happy. The challenge has been finding radiologists in the first place.

“We don’t have any radiologists on staff,” Sumra says. “That’s the challenging part of our setup. We had a radiologist who came to Cavalier three days a week, but when he retired, we were left without anyone.” The rural hospital produces 20 or 30 studies a day, many of them trauma cases, but recruiting a radiologist who’s willing to move to this remote corner of North Dakota is next to impossible. “Most radiologists don’t want to come to a rural area like this,” Sumra says.

Fortunately for Sumra and his team, when the part-time radiologist retired in 2004, Emergency Radiology Services LLC (ERS), operated by St Paul Radiology, St Paul, Minn, was able to take over—from a distance. Pembina turned over both its night interpretations (four or five a day, according to Sumra) and its day readings to ERS, purchasing final interpretations with billing from the teleradiology provider. When NightHawk Radiology Services LLC, Coeur d’Alene, Idaho, acquired the St Paul Radiology business office in 2007, this program became known as Finals Plus, the service Pembina currently uses.

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Changing Vendors: Costly Mistake or Wise Move?

by Arun Jethani and Tamara Labrecque

Vendor relationships can be tough, and many end in a heap of disappointments, unfulfilled expectations, and miscommunications. If your vendors didn’t deliver, is it your fault or theirs? What really went wrong? Can you fix it? These are million-dollar questions.

This article is the first of two on building strong vendor relationships. This installment will help you assess whether it’s time to build better relationships with your current vendors or switch to new vendors. The second article will focus on specific due diligence needed to choose vendors appropriately.

First, you must ask yourself why you are dissatisfied. The most common reasons for dissatisfaction aren’t surprising: the service costs too much, the vendor is not performing service within the expected time, service is poor or inconsistent, or you are not earning your expected results. Without knowing what’s really causing your problems, you may get into the same situation with a new vendor. If you find yourself dissatisfied with your vendor, make sure you’ve got your facts straight – on yourself and the vendor.

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