Published on the Jan. 28, 2016 DiagnosticImaging.com website
By Whitney L.J. Howell
Mergers and acquisitions have been a radiology conversation topic for several years. The number of practices melding hasn’t increased significantly, but it’s a possibility that concerns many.
If you’re facing this decision, industry experts have guidance on when it might be beneficial and what you can expect in 2016.
Reasons to Conjoin
There are several reasons for considering a merger or acquisition, according to Lawrence Muroff, MD, the chief executive officer and president of consulting firm Imaging Consultants, Inc., and radiology professor at the University of Florida and University of South Florida Colleges of Medicine,.
“Typically a merger or acquisition provides protection or is for the perceived or actual need to provide specialty expertise on an around-the-clock basis or for the opportunity to confront or negotiate with your hospital system to step-up and take responsibility for the entire system,” he said.
You’ll likely merge or acquire for one of these reasons:
To read the remainder of this article at its original location: http://www.diagnosticimaging.com/practice-management/how-survive-merger-or-acquisition-radiology
Published on the Jan. 14, 2016 DiagnosticImaging.com website
By Whitney L.J. Howell
No radiologist, radiology practice, or department is an island. Without partners of all sorts, a radiologist cannot succeed. The inter-related nature of providing quality health care services and optimal patient care requires a well-tuned, communicative team made up of many members.
While your office colleagues are integral to a radiologist’s success, they can’t be the only other players to comprise the team. To be truly effective, radiologists must cultivate and maintain open relationships with other stakeholders – referring physicians, hospitals, technologists, and, most importantly, patients.
According to industry leaders, there are reasons behind why each relationship is important, as well as tactics you can use to strengthen each connection.
For the American College of Radiology (ACR), understanding and supporting ongoing relationships between radiologists and referring physicians or hospital administrations is vital to underscoring the most effective patient care possible. And, these groups always tell the ACR the same things when asked to name the most important characteristics of a successful, trustworthy radiology partner.
Every hospital surveyed reports the need for radiology partners that are aligned with the health systems’ overall goals – ones that take the time to unearth priorities, stumbling blocks, and upcoming efforts, according to Geraldine McGinty, MD, MBA, chair of the ACR Commission on Economics. Everyone is looking for a radiology group invested in the hospital’s long-term growth.
“Make sure you’re around and visible. Show up to medical staff meetings. Show up and commit to being an active participant with the intricacies of the hospital,” McGinty said. “Get to know the people you work with, and understand their challenges. Those are important things.”
There are several steps needed to reach this goal, she said. After discovering what’s important to them and committing the time and energy investment needed for a solid relationship, identify the people in your department or group you feel most comfortable sending in to talk with hospital administrators. Not everyone will be good for this job, but try not to rely on fewer than three people.
Most importantly, she said, pitch in and keep a positive attitude. Be part of any solution and never part of the problem.
“It’s a bad idea to assume what’s important to any other party. Don’t assume you know their wants and needs. Ask them,” McGinty said. “Spend your time learning about what they consider to be important and what their strategies are.”
To read the article published at its original location: http://www.diagnosticimaging.com/practice-management/how-radiologists-can-get-along-everyone
Published on the Dec. 23, 2015, DiagnosticImaging.com website
By Whitney L.J. Howell
When electronic health records (EHRs) were first introduced, they were touted as being the answer to managing all patient data. An easy way to keep all medical data in one central location, accessible by all medical providers, and beneficial to patient care overall.
That was the initial intent, said Rena Zimmerman, MD, a radiation oncologist at Olympic Medical Center in Sequim, WA.
“Electronic health records should be intuitive to use, improve efficiency, reduce administrative responsibilities, not interfere with patient relationships, and be interoperable,” Zimmerman said. “They must be fully supported by your IT department, be completely secure, and improve patient outcomes and the health of the nation.”
But, that’s not what’s happened, she said at this year’s RSNA. Instead, EHRs are rife with challenges that make full, effective implementation difficult.
Medication Reconciliation: Under Meaningful Use guidelines, you’re required to review medication lists with 50% of your patients, including all prescription medications, herbal supplements, and over-the-counter medicines. Based on existing data, though, more than 60% of medical records contain errors of omission, addition, or both, even though providers have had several years to figure out how to manage medication records correctly.
“At this point, the learning curve isn’t the problem,” she said. “Most physicians feel the system is so cumbersome that they’ve sort of given up. There’s a belief that they don’t believe the medication record anyway, so they just put something, knowing that it’s probably not right.”
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/news/where-ehrs-fall-short
Published on the Dec. 23, 2015, DiagnosticImaging.com website
By Whitney L.J. Howell
Today’s radiologists do more than examine images and diagnose problems. They’re expected to understand revenue streams, keep up with coding and billing updates, and participate in mergers and acquisitions decisions.
But, currently, Falgun Chokshi, MD, MS, assistant professor of radiology and imaging services in the neuroradiology division at Emory Healthcare said at RSNA 2015 said, too few radiologists are prepared for these types of activities.
“Providing business leadership skills is a way to empower our trainees so they can go into a complex and very rapidly changing world of radiology and health care delivery and become active players,” he said. “These teachings provide valuable and necessary nonclinical tools, knowledge, and insight that have historically never been afforded in our training environment.”
The most effective way to impart this knowledge, he said, is to create a targeted curriculum and identify residents and fellows who could benefit from it the most. At Emory, this effort is known as P3R2 – Practice, Policy, and Professionalism for the Radiology Resident. Chokshi shared some lessons learned.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/rsna-2015/teaching-radiologists-be-business-leaders
Published on the Dec. 18, 2015 Burroughs Wellcome Fund website
Asking Questions in the Great Smoky Mountains
By Whitney L.J. Howell
In the Great Smoky Mountains, Madison High School senior Chloe Schneider discovered something she never knew before. The mountains are home to a rich variety of snail species – but, some of them are in severe trouble.
Ordinarily, knowing details about the state’s mollusk population serves as a random bit of trivia for a party game. But, for Schneider, this knowledge was critical. Nearly 50 percent of North Carolina’s snails are endangered, but the ones in the Great Smokies are losing ground thanks to environmental changes.
The Millenial Youth Led Expedition (MYLES) of Science program showed the Marshall, N.C. native why it’s important to understand the impacts on the snails’ ecosystem.
“We could really tell how the acid rain has affected the environment and, how if we continue to have acid rain and pollution in the environment, that things will only get worse. Snails won’t be able to live in those areas anymore,” said Schneider, describing the work of her six-person team. “It’s crazy to see how much impact we have and how what we release into the environment can affect other species.”
MYLES, a Burroughs Wellcome Fund (BWF)-supported initiative, introduces high school students to science along the Appalachian Trail. BWF funded MYLES in 2013 with a nearly $60,000, three-year grant to support up to 100 participating students. Over the past two years, according to Dottie Shuman, Ph.D., MYLES grant administrator, surveys conducted at the beginning and end of each week-long program show the program meets BWF’s goal of fostering an augmented interest in and knowledge of science.
During six week-long summer expeditions, she said, students work alongside college-student guides and National Park Service (NPS) rangers, learning protocols and collecting data about the Western N.C. mountains to support long-standing NPS research projects. Students can also present their findings at scientific conferences throughout the school year.
“These students are excited about real science – testing hypotheses and setting up data collection,” she said. “They come back with knowledge about the natural resources at our fingertips, and they’re excited about protecting them.”
And, students don’t leave the program empty-handed – they take some scientific equipment with them. They carry hand lenses and water-test kits home to continue their investigations on their own.
In addition, according to NPS ranger and MYLES program staffer Susan Sachs, program staff hope students will leave MYLES thinking of science as a viable career option.
“A lot of times when students think of science, they think of lab coats and being indoors,” Sachs said. “We want to show them how we use science to study and protect the parks.”
To meet this goal, students participate in on-going NPS research into snail and salamander habitats and the outside influences affecting them. The six-person teams are also encouraged to form their own research questions and hypotheses, but all data gathered contributes to the investigations that have been active for at least a decade, Sachs said.
For example, this past summer, several teams examined how acid rain has impacted the mountain’s snail and salamander populations. Air quality in the area has improved over the past 10 years, but damaging rains still fall with greater amounts hitting the higher elevations, she said. Teams gathered data about soil pH and species diversity, compared it to historical data, and analyzed whether said diversity has increased or decreased over time. They determined, Sachs said, that fewer salamanders now live in the more highly-acidic, upper elevations.
“We use student data to look at salamander health. We might not notice the decline in population if we didn’t have the data students collect,” she said. “This way, we can monitor how changes in moisture and climate change affect these amphibians.”
Frequently, students take their new-found knowledge back into the high school classroom. In fact, two-time participant and high school junior Jalen Ward said hands-on experience with forming hypotheses and analyzing data has been helpful in his advanced placement science classes at Fike High School in Taylor, N.C. But, more importantly, he said, it’s impacted his future plans.
“I’d like to major in biology and maybe be a wildlife biologist working with North Carolina’s wildlife,” he said. “I enjoy the outdoors, so working with nature would be a way to do for a living what I already love to do.”
It’s that type of insight into the value of science as a career and forward-thinking that makes the MYLES program so important, Sachs said. It doesn’t take long for students to develop a deep appreciation for the significance of outdoor science and the opportunities for investigations it presents.
“After this program, science isn’t just something they learn in school. There’s a real value to it,” she said. “A lot students think we do a study and have answers. But, they learn that questions often only lead to more – and better questions.”
To read the story at its original location: http://www.bwfund.org/newsroom/awardee-profiles/myles-go
Published on the Dec. 16, 2015 Carolina Public Press website
By Whitney L.J. Howell
In the middle of Western North Carolina sits one of the state’s most potentially dangerous time bombs. And, at any given moment, under the right circumstances, it could go off.
Despite North Carolina’s requirements that school-age children have up-to-date vaccinations before starting kindergarten, 5 percent of Buncombe County’s kindergarten population remained unvaccinated for the 2014-15 school year. Statistics for the 2015-16 school year are not yet available.
According to Dr. Jennifer Mullendore, medical director for Buncombe County Health & Human Services, the percentage is higher than previous years and is six times the state average.
With up to 20 percent of each of the county’s schools allowed to be unvaccinated, the possibility exists for a significant public-health crisis, she said.
“We’re holding our breath, waiting for an outbreak,” she said.
“We’re fortunate the measles outbreak in California (in April) didn’t make it here. Next time, we might not be that lucky.”
In North Carolina, a child can remain unvaccinated for two reasons: a medical exemption and a religious opt-out. Based on N.C. Department of Health & Human Services statistics, out of
Buncombe’s 2,488 kindergarteners, one has a medical exemption, including a waiver from a healthcare provider, and 125 opted out for religious reasons. Or at least that’s officially what they claim. The state does not offer a philosophical exemption, even though that’s exactly what some anti-vaccination groups in Buncombe Cuonty have advocated. It’s likely that not all “religious” waivers are faith-based.
Upon kindergarten enrollment, parents must present schools with their child’s official immunization record. Schools keep these records on file, including any medical or religious exemptions. Children without exemptions have 30 days to provide proof of immunization or they aren’t allowed to return to school.
In addition to Buncombe County, Polk County and Transylvania County round out top three WNC locales with the highest non-vaccinated rates, reporting 4.71 percent and 2.89 percent non-vaccinations, respectively.
Henderson County has the second highest total number of children without vaccinations — with one medical waiver and 14 religious exemptions. However, because this is a relatively large county for WNC, it’s rate is not especially out of the range seen in most counties across the state.
Although no widespread outbreaks have occurred, Buncombe frequently experiences a higher-than-average incidence of pertussis, also known as whooping cough, a highly contagious respiratory disease known for uncontrollable, violent coughing that makes it hard to breathe.
Despite being preventable with a vaccine, in 2014, Mullendore said, the county had 65 reported cases. Only Duplin County, a rural county near the coast known for its pig farms, had more with 138 cases.
There were 782 cases of whooping cough reported statewide in 2014.
But, knowing the reasons behind the high non-vaccination rate is difficult, Mullendore said.
“We suspect immunizations have done a great job keeping people healthy for 50-plus years, and people don’t have context for why immunizations are important,” Mullendore said.
“People who grew up in the 1960s had friends and family who died from diseases that we have vaccines for now. Younger people raising kids now never saw that, so we’ve lost that perspective.”
Immunizations for North Carolina’s children are free through the Vaccines for Children program, even for uninsured individuals. It’s possible, though, other factors that typically limit access to healthcare are also at play, including cultural or language barriers that make it difficult to take advantage of healthcare services, and, in this case, a low level of education about vaccines.
Tara Rybka, public health educator with the Transylvania County Public Health Department, said that although it’s never been directly connected to a lack of immunization, transportation difficulties frequently play a role in limiting access to healthcare services in counties like hers.
In many cases, Mullendore said, parents research vaccines on their own, trusting potentially non-vetted, online sources rather than asking their pediatrician or other healthcare provider for information about possible risks and benefits associated with vaccinating their children. Some choose not to vaccinate based on their online findings, leaving the overall community more vulnerable to preventable disease.
Doing so is particularly dangerous, said Noel Brewer, associate professor of health behavior at the University of North Carolina at Chapel Hill Gillings School of Global Public Health.
Vaccines provide herd immunity, he said, protecting the vaccinated and sheltering those who can’t receive vaccines due to conditions that compromise their immune systems, such as cancer.
On the flip side, however, non-vaccination can also create herd sensitivity, a phenomenon that gives rise to more severe cases of disease as individuals get sick at older ages.
Since most people are vaccinated, the risk of herd sensitivity might not seem too bad. But Brewer said this perception is misleading.
“Herd sensitivity is worse than people think,” he said. “Birds of a feather flock together, so those who are unvaccinated tend to stay together. But, you never have a pocket where 95 percent of people are vaccinated. It’s usually spread out to 80 percent or it can fall to 50 percent. These are the places that are vulnerable to outbreak and the spread of disease.”
Even with the risks of non-vaccination publicized throughout the healthcare community, Buncombe County has a relatively active anti-vaccine cohort, including Moms Against Mercury.
Based in Leicester, this organization, which did not return calls for comment, publicizes and supports the belief that mercury present in vaccines adversely affects the nervous system.
In recent years, the group has held six rallies, lobbying against the use of vaccines in their current forms.
According to the Centers for Disease Control & Prevention (CDC), though, the type of mercury used in vaccines – ethylmercury – is metabolized and cleared from the body far faster than the type of mercury – methylmercury – present in some types of fish. Consequently, CDC data states, ethylmercury is far less likely to be harmful.
Educating the public
County health officials are working to combat anti-vaccine efforts, Mullendore said. Last year, the Department of Health & Human Services worked with healthcare and childcare providers to expand educational services around the facts and benefits of vaccinating children.
Rather than targeting staunch anti-vaccine proponents who tend to dig their heels in when faced with information that contradicts their beliefs, health officials are reaching out through public forums to parents who are curious about vaccines. The effort could ultimately influence those who are on the fence about whether to vaccinate to proceed with immunizations.
Jennifer Garrett, director of nursing with Macon County Public Health also suggested holding school-based vaccination clinics to reach students who aren’t yet vaccinated. Macon’s health officials also reach out via phone to non-compliant parents to set up appointments for children to be vaccinated.
Ultimately, though, UNC’s Brewer said, the onus is on parents in communities with unvaccinated children to take steps that will side-step exposure to preventable disease. When children are sick, keep them home from school, he said, and know which pediatricians still choose to treat children who don’t have current vaccinations.
And, Brewer added, public health officials should continue to push for more widespread vaccinations.
“Getting information into the hands of those who are vaccinated can be helpful,” he said.
“More information needs to come from educators and physicians in the community. Not everyone will want to vaccinate, but more people are open to it than we currently believe.”
To read the story at its original location: http://www.carolinapublicpress.org/23894/clusters-of-unvaccinated-kids-create-wnc-health-time-bomb
Published on the Dec. 11, 2015, DiagnosticImaging.com website
By Whitney L.J. Howell
Residency is an intense time in the career for any radiologist. There’s much to learn and practice. Finding ways to do it all well can be an intimidating task. And, doing so can be particularly challenging if you don’t get the right guidance.
At this year’s RSNA, Rachel Nelson, MD, senior radiology resident and former chief resident at the Medical University of South Carolina, had advice for how residents can best navigate – and maximize – their training.
“Residency is daunting and difficult from the moment you first walk through the door,” Nelson said. “You need to know the tools you can use and find the support along the way to make the four-to-six years go smoothly.”
• Foundation: When you begin residency, she said, focus on developing the skills you need that will help you with advanced learning as you progress.
• Anatomy: In many ways, radiology is applied anatomy. Learn what normal – and the variations of normal – look like so you can identify when something is wrong. Focus on understanding how normal outcomes present on each modality.
• Pathology: Once you’ve mastered anatomy, she said, move on to pathology and pathophysiology. It’s important for you to be able to recognize what condition or problem you’re dealing with so you can provide better information to referring physicians and surgeons. Understanding the pathology can also better position you to help the patient achieve his or her “new normal.”
• Physics: You don’t need to be a physics expert, Nelson said, but it’s a field that’s fundamental to radiology. Educate yourself on some of the basics, learn how an X-ray is made, and study the Compton Effect. Not only will this knowledge help you when you’re studying for your board exams, but it will also be useful as you begin working with more advanced modalities.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/rsna-2015/how-make-most-radiology-training
Published in the Fall 2015 University of North Carolina at Chapel Hill Gillings School of Global Public Health Carolina Public Health Magazine
By Whitney L.J. Howell
Globally, the number of people 60 years old and older is growing exponentially. By 2050, these individuals will constitute nearly one-quarter of the world’s population.
Identifying strategies that will allow adults to age safely and with good quality of life, to maintain their abilities and safeguard their independence is vital – and is a high priority at the UNC Gillings School of Global Public Health.
“People are aging – me included – and we need a plan to help them live fully,” says Julie MacMillan, MPH, managing director of the School’s Research and Innovation Solutions office. “At the Gillings School, through strong collaborations, we want to create opportunities for people to live as healthfully and independently as possible.”
School leaders take a three-pronged approach to meeting those needs, including innovation, evaluation and education. Partnerships through the Gillings Global GatewayTM (sph.unc.edu/global-health) offer support.
Identifying needs is a first step, MacMillan says.
Peggye Dilworth-Anderson, PhD, professor of health policy and management, collaborates with UNC and Cambridge University (U.K.) colleagues to reduce later-life dementia risks. Using community-based participatory research, her team explores relationships between cognitive health, protective factors and modifiable risk factors to help develop cognitive, health-sustaining interventions that can be used with vulnerable groups of older adults in the U.S. and U.K.
Dilworth-Anderson is a venerated national leader in aging issues, having served as a Presidential appointee on the White House Conference on Aging Advisory Committee (2002-2005), president of the Gerontological Society of America (2009-2010) and appointed member of the Institute of Medicine’s Forum on Aging, Disability and Independence (2012- 2014). In October 2015, she was invited by AARP, in partnership with AgeUK (ageuk.org.uk), to serve a two-year term on the governance committee of the new Global Council on Brain Health (aarp.org/gcbh). The committee includes physicians, scientists, policy experts and others who will recommend best practices regarding brain health maintenance.
Funding for some of the UNC-Cambridge initiative was provided by Drs. Dennis and Mireille Gillings. Dennis Gillings, PhD, CBE, appointed by U.K. Prime Minister David Cameron as World Dementia Envoy, leads a global council to raise funds for research toward a cure for Alzheimer’s disease and other dementias.
Wayne Rosamond, PhD, epidemiology professor at the Gillings School and adjunct professor of emergency medicine in the UNC School of Medicine, identifies ways emergency medicine services (EMS) staff can communicate with hospitals while en route. These strategies could ensure immediate availability of emergency department resources, personnel and scanning equipment, of special importance in situations such as stroke, in which a few minutes can make a big difference in prognosis. Steve Marshall, PhD, epidemiology professor and director of the UNC Injury Prevention Research Center, and Jason Franz, PhD, biomedical engineering assistant professor, study factors that contribute to adult falls.
Epidemiology postdoctoral fellow Vineet Menachery, PhD, is using a recent National Institute on Aging award to support his research on the SARS coronavirus. He is identifying changes in immune response in the context of aging that could modify treatment of older adults who develop respiratory infections, a leading cause of death in that population.
The Global Aging and Technology Collaborative aims to promote innovation and collaboration with global partners, says Heather Altman, MPH, project manager for the collaborative and doctoral candidate in the School’s Executive Doctor of Public Health program. The group leverages the expertise of more than 100 interdisciplinary researchers, practitioners and entrepreneurs to adopt creative, affordable and practical solutions that enhance quality of life and support people’s ability to age at home and in their communities. Altman is also Carol Woods Retirement Community’s community connections director, a long- held position that inspires and continues to enrich her work in aging at the UNC Gillings School.
With the help of a career development award from the UNC Institute on Aging, Altman is evaluating a tool that will help leaders assess the livability of their communities for older adults.
Gillings School students also learn about older adults’ challenges, including food insecurities, by working with Amanda Holliday, MS, RD, clinical assistant professor of nutrition and licensed dietitian/nutritionist.
“Living older with chronic conditions has a nutritional component,” Holliday says. “Independence is intertwined with food. We need to consider how each person will manage his or her own nutrition if s/he wants to stay at home.”
Holliday’s students investigate older adults’ struggles in several ways. They complete daily living activities in a suit that impairs hearing and eyesight. Holliday also connects students with alumni living abroad to learn how other societies care for older adults, and she helps them secure study-abroad opportunities focused on aging, such as with the National Health Service’s Universal Malnutrition Screening Initiative, in England.
Overall, MacMillan says, the School prepares students to be leaders in a number of public health arenas. “When our students get excited, they’re a powerful force, no matter what challenge they take on,” she says. “They always make us think – and make us stronger. I’m particularly proud of our students who seek solutions for the challenges of aging, because they will make a difference in all our lives – and eventually, in their own.”
To read the article at its original location: http://sph.unc.edu/cphm/the-challenges-of-healthy-aging/