Published on the Jan. 15, 2015, DiagnosticImaging.com website
By Whitney L.J. Howell
Unnecessary imaging and appropriateness criteria. These two phrases have dominated radiology discussions for the past several years. It’s a complicated topic that has an even more complex, and elusive, answer.
And, according to industry leaders, one of the most critical components to the discussion is the role radiologists play in limiting the number of unnecessary and duplicative imaging studies performed.
“Radiologists get painted as these selfish people who are self-interested and who are going to fight against change,” said Jeremy Bikman, chief executive officer for peer60, a big data survey company that provides analysis based on conversations with on-the-ground professionals. “But, they didn’t create their reimbursement structure. It comes from the Centers for Medicare & Medicaid Services, and radiologists are just doing the best they can.”
That performance includes responding to and meeting referring physicians’ needs and desires, which, frequently, he said, can be wasteful. A recent peer60 report puts the nationwide cost of unnecessary imaging between $7.47 billion and $11.95 billion annually.
To reach the article in its entirety at its original location: http://www.diagnosticimaging.com/practice-management/what-can-radiologists-really-do-about-unnecessary-imaging
Published on the Jan. 12, 2015 DiagnosticImaging.com website
By Whitney L.J. Howell
CHICAGO — For several years, there’s been a push in health care – particularly in pharmaceuticals – toward personalized medicine. By using a patient’s genetics to better target their medications and therapies, the medical industry has achieved improved patient outcomes.
But, what if you could launch individualized care at an earlier stage – at the point of pathological diagnosis? According to radiology and pathology experts at the 2014 Radiological Society of North America annual meeting, this could be the next wave that takes personalized medicine to the next level.
“The idea is to personalize how we treat patients based on their unique characteristics,” said Mitch Schnall, MD, PhD, radiology department chair, University of Pennsylvania. “The idea of developing data that characterizes someone really gets to the heart of what diagnosis is about. It’s crucial to realizing any benefit.”
To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/radiology-and-pathology-time-integrate
Published on the Dec. 3, 2014, DiagnosticImaging.com website
When it comes to big data, health care doesn’t really have any. And, for radiology, that’s a good thing. Small and medium data will work just fine – especially for testing and designing new reimbursement models, according to speakers at this year’s Radiological Society of North America (RSNA) meeting.
Industry experts at this year’s RSNA say the data hospitals and health care systems already have can help providers identify ways to maximize their influence in the design of any future payment models.
“We’re currently in the lowest life form of payment policy. We get paid for events – it’s a transactional delivery system,” said Richard Duszak, MD, vice chair for health policy and practice, department of radiology and imaging sciences, Emory University School of Medicine. “Increasingly, we’re moving to models where we’ll be paid by encounters and engagements.”
The question, he said, is how those models will be designed to ensure radiologists receive appropriate reimbursement for services rendered in a correctly incentivized way. To date, there’s no clear-cut answer, but there are steps radiologists can take – armed with small-to-medium data – to ensure their seat at the decision table.
To read the article in its entirey at its original location: http://www.diagnosticimaging.com/rsna-2014/no-such-thing-big-data-health-care
Published on the Dec. 16, 2014, DiagnosticImaging.com website
By Whitney L.J. Howell
CHICAGO — It has been six years since the Radiological Society of North America (RSNA) launched its Reporting Initiative. In that time, radiologists across the country have benefited from the tools it offers, according to the Initiative’s leaders and other industry experts, who revealed its accomplishments to date and discussed what’s yet to come.
“Our goal, in part, was to improve the quality of radiology reports, making it easier for referring physicians, patients, and other radiologists to use and have the information that we can extract from reports,” said Charles Kahn, MD, chair of the RSNA’s Radiology Informatics Committee Structured Reporting Subcommittee. “We wanted to develop a better, more robust system that could go beyond speech and voice recognition and really empower the capture of information as radiology becomes more quantitative.”
Rather than dictating to radiologists and practices exactly how they were to create reports, this initiative was designed to collect a sampling of best practice templates that providers could modify to meet their own needs, he said.
To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/rsna-collaborates-sets-improve-radiology-reporting
Published on the Dec. 22, 2014, DiagnosticImaging.com website
By Whitney L.J. Howell
CHICAGO — With the roll-out of the Affordable Care Act (ACA) still ongoing and the move toward some type of accountable care organization model still underway, it’s unclear how radiology will fare in any medical malpractice lawsuits.
But, industry experts at this year’s Radiological Society of North America meeting all point to one key component of financial survival – communication. Communication with referring physicians, the patient, and each other.
“You have to remember there are three factors to communication – the referring physician, the radiologist, and the patient,” said Leonard Berlin, MD, a radiologist with NorthShore University Health System. “Communication is the link between all three. It’s obviously a real problem when there’s a failure to communicate emergency or acute findings, but it’s significant that there’s a large amount of significant and unexpected findings that don’t get communicated either.”
To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/avoid-malpractice-radiologists-must-communicate
Published on the Dec. 24, 2014 DiagnosticImaging.com website
By Whitney L.J. Howell
CHICAGO — The buzz about clinical decision support and the need for appropriateness guidelines isn’t new, but implementing and using such tools correctly will soon become even more critical.
According to industry experts at this year’s Radiological Society of North America annual meeting, if your referring physicians don’t master their clinical decision support (CDS) and use it consistently, it’s going to cost the radiologists money.
As of Jan. 1, 2017, said Ramin Khorasani, MD, vice chair of the Brigham & Women’s Hospital radiology department, under the Protecting Access to Medicare Act, radiologists won’t be paid for outpatient, non-emergent services rendered if their claims don’t include a number that proves the referring physician consulted a CDS tool.
But it still isn’t clear how radiology can best teach other providers about diagnostic imaging appropriateness. A recent pilot initiative, the Medicare Imaging Demonstration (MID), showed some improvement in how referring physicians prescribed imaging, but many doctors and surgeons reported dissatisfaction with the CDS software.
To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/why-radiologists-should-care-about-clinical-decision-support
Published on the Dec. 26, 2014, DiagnosticImaging.com Website
By Whitney L.J. Howell
CHICAGO — As of July 2014, 32 states either had a breast density notification law or were working on legislation. Connecticut passed the first law in 2009, but what has been the impact to-date on identifying the sneaky cancers that hide?
According to industry experts at this year’s Radiological Society of North America meeting, new cancers are being found, but radiologists have learned something else in the process. Dense breast tissue doesn’t necessarily raise a woman’s risk of breast cancer – instead, it more directly affects the sensitivity of the test she receives.
“The increased rate of breast cancers in dense tissue is largely due to masking – the obstruction of the cancer by the dense tissue,” said Stephen Feig, MD, a radiologist at the University of California-Irvine with an interest in breast screening guidelines and controversies. “Dense breast tissue is much less associated with an actual higher risk of developing the disease than was originally anticipated.”
To read the story in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/mixed-messages-about-breast-density-risk-factor
Published on the Dec. 17, 2014, North Carolina Health News website
Many health care practitioners find themselves overwhelmed and depressed, yet there are few outlets for them to get help. A program at UNC-Chapel Hill is targeting doctors who are burnt out.
By Whitney L.J. Howell
Kara McGee knew something was wrong when she felt all the excitement over her job and empathy for her patients draining away.
“I wasn’t missing things, but it was definitely a more ‘here we go again’ attitude,” she said. “I didn’t want it to happen, but I was disconnecting from what I was doing. It felt like it was protective, like it was my way of coping with what I was seeing on a daily basis. I felt very out of control.”
At the time, McGee was a physician assistant, working in a pediatric surgery and intensive care unit in Miami. Being surrounded by so many children who were dealing with such intense medical issues made it difficult for her to concentrate on the patients who had good outcomes. Instead, McGee said, she dwelled on those who suffered from long illnesses and died.
So she quit. McGee walked away from patient care for three years. During that time, she went back to school to earn a master’s degree in public health, but eventually returned to working with patients after realizing she missed it. It’s different now though. Today she works in HIV medicine at Duke University Medical Center’s Division of Infectious Diseases.
“Now, I can develop long-term relationships with my patients, and that’s extremely rewarding,” McGee said. “In the ICU or emergency department, there’s either a poor outcome or you don’t know what happens because patients go on their merry ways. It’s the relationship building that’s so gratifying.”
Based on existing research, McGee isn’t alone. Medical professionals are more likely than people in other professions to experience burnout. Studies have looked at burnout prevalence among physician assistants and other health care providers. But until now, there’s one group that’s gone without much examination: medical residents, the physicians-in-training.
According to new work conducted by researchers at the University of North Carolina-Chapel Hill though, as many as 75 percent of medical residents experience at least one time period of burnout, and roughly 50 percent identify themselves as burned out at any given time.
“This is an extremely common problem. The academic medicine centers
responsible for training our doctors are under extreme pressure these days,” said Samantha Meltzer-Brody, the lead study investigator. “The entire business of academic medicine and the structure of it are built upon a system that no longer works, and no one is entirely sure what to do about it.
“Residents are on the front lines of providing the care, and I think they feel it acutely.”
Treating the malaise
Physician burnout is a national problem that, in some cases, contributes to an even greater concern: physician suicide. According to Pamela Wible, a family physician and physician-suicide expert, approximately 400 doctors take their own lives annually, and many leave behind letters or evidence of their daily mental stresses.
Meltzer-Brody’s goal is to identify, treat and diffuse those mental stresses and other mental health concerns before residents reach that level of despair.
Increased patient demands, battles with insurance companies, malpractice concerns and medical school debt are known contributing factors to physician burnout. But, according to Meltzer-Brody, who also directs the Perinatal Psychiatry Program in the UNC Center for Women’s Mood Disorders, residents face additional, more contemporary challenges. To identify the residents’ stress mix, she conducted an online survey with 310 UNC HealthCare residents.
In May and June of 2014, she collected survey results from residents in various specialties, including surgery, internal medicine, pediatrics and psychiatry. The questions queried about interpersonal situations, fatigue, depression and feelings around patients who died. Meltzer-Brody noted residents likely had additional stress during this time because they were training to use the UNC Healthcare system’s new electronic health record system, Epic.
Through this survey and her ongoing mental health program for physicians, “Taking Care of Our Own,” Meltzer-Brody has put North Carolina at the forefront of combating this phenomenon. This UNC-based, first-of-its-kind initiative is specifically designed to treat physician burnout by providing education, confidential support services, advice and mental and physical health referrals.
Within its first year, from 2012 to 2013, the program grew by 200 percent.
What residents are feeling and facing
North Carolina’s medical residents face a challenge that could make resident risk of burnout more severe, Meltzer-Brody said.
“We have a growing population that is very diverse. North Carolina is the fifth largest state taking care of Latinos, many of whom are undocumented and use the emergency room as their first point of care,” she said. “The UNC emergency room is exploding as we try to meet the health needs of this influx of people.”
Rural physicians face this same challenge, often having to provide emergency room and hospital coverage in addition to their clinic duties. A significant cadre of physicians and residents in North Carolina fall into this category. According to the N.C. Department of Health and Human Services, 150 to 160 physicians were recruited annually for the past six years to serve the state’s rural populations.
At the same time that there are more patients in waiting rooms, there are fewer residents on call due to a 2003 federal regulation that limited residents to an 80-hour workweek in an effort to create more well-rested residents and increase patient safety.
“The thought was that if residents were more rested, it would decrease medical errors, as well as improve their mental well-being,” Meltzer-Brody said. “Neither has happened. We’re not seeing reduced medical errors, and burnout is at an all-time high.”
Additionally, academic medical centers haven’t increased their resident numbers or hired other personnel, leaving a smaller group of residents responsible for an ever-growing body of work. All these factors contribute to increased daily stress, she said.
Reports from the Physicians’ Foundation revealed that these issues led to 81 percent of doctors finding themselves overextended and half being unlikely to recommend a medical career.
Together, these factors leave little time for team building or mentoring, eroding the sense of community that once existed between residents, attending physicians and other health care personnel, Meltzer-Brody said. Losing that cooperative spirit can fuel a significant burnout feeling.
“What these residents experience isn’t what brought them into being doctors,” she said. “There’s a big disconnect between what’s being emphasized in medical school and what’s happening in actual practice.”
Whatever the symptoms, McGee recommended residents or other health care professionals identify someone with whom they can discuss both their physical and mental reactions to work-related stress.
“I think seeking help from employee-assistance groups is an excellent way to cope with the stress you experience as a medical professional,” she said.
In addition, she suggested individuals experiencing burnout take time for self-reflection. If someone’s ability to provide appropriate, compassionate care is compromised, then it’s time to take a break and try something different professionally.
Ultimately, the biggest force behind burnout among medical professionals is the industry’s culture, McGee said, and practitioners need an outlet.
“It’s just like with professional athletes who get injured and play anyway,” she said. “Part of what you do in having to deal with the stress and the patient care is simply putting one foot in front of the other. It’s the culture of medicine that just comes with the territory.”
To read the story at its original location: http://www.northcarolinahealthnews.org/nc-research-news/