Whitney Palmer

Healthcare. Politics. Family.

How To Be The Perfect Radiology Group

Published on the DiagnosticImaging.com website on Feb. 19, 2015

By Whitney L.J. Howell

You have reimbursement woes. You worry about your billing practices. You wonder if you’re doing the right things to demonstrate your value to partner hospitals. The daily stresses can be nearly overwhelming – but, if you were a perfect radiology group, these worries wouldn’t exist.

The perfect radiology group has tweaked its day-to-day activities. Their streamlined coding process ensures proper payment. Their targeted marketing attracts more referring physicians, and personnel tactics secure a seat at the administrative decision-making table. Every day, for the perfect radiology group, operations are smooth.

But, is the perfect radiology group really attainable? Not really, industry experts acknowledge, but it’s possible for you to get close. Later this year, the American College of Radiology (ACR) will release a road map for creating your “optimal” radiology practice or department. In it, according to Mark Bernardy, MD, chair of the ACR Managed Care Committee, you’ll find a list of best practices that were tested at the ground level, and can help you on your way. Consider it an expansion of ACR’s Imaging 3.0.

“Imaging 3.0 has laudable big picture ideas. Everyone nods their head that it sounds good and right. But, then, exactly what is it that you want me to do?” said Bernardy, who is also a practicing Georgia-based radiologist. “There’s a big gap. I thought it would be useful to go through the exercise of writing down what it is we mean when we say, ‘This is what the perfect radiology group looks like.’”

As a compilation of best practices gathered from large medical centers and small private practices nationwide, it will be a living document, open to modification with new, effective ideas, he said.

Read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/how-be-perfect-radiology-group?cid=tophero


February 23, 2015 Posted by | Healthcare | , , , , , , , | Leave a comment

Patient Steerage Could Harm Radiologists, Confuse Patients

Published on the April 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

As implementation of the Affordable Care Act continues, all sectors of the healthcare industry are being called upon to increasingly rein in costs. For many insurance providers, patient steerage has proven to be an effective strategy. But the impact on radiology has been largely negative, industry experts said.

Patient steerage in radiology occurs when outside forces — usually insurance providers — actively direct patients or physicians to lower-cost radiology practices. And, this strategy is becoming more prevalent nationwide, said Geraldine McGinty, MD, chair of the American College of Radiology’s (ACR) Commission on Economics.

“Our feeling is that as radiology benefit managers have maxed out on the initial imaging volume savings they can offer to clients, so they’ve started participating in programs to drive patients to facilities where the payers have negotiated lower reimbursement rates,” she said. “Recently, it’s been more aggressive due to increasing involvement of patients as they take on more responsibility for their care through higher-deductible plans.”

In fact, according to an informal survey by the Radiology Business Management Association (RBMA) in September 2012, 65 percent of respondents reported experiencing active patient steerage from either radiology business management (RBM) groups, payers, or both. With active steerage, payers give patients incentives, such as gift cards, for choosing lower-cost providers. In addition, 47 percent confirmed the presence of passive steerage — simply making cost differential data available to patients and providers.

However, patients are also driving a certain level of steerage. A recently-published joint ACR-RBMA paper credits high-deductible insurance plans and patient cost awareness with some patient redirection.

What Payers Are Doing

While not all payers have patient steerage programs, many do. For example, in September 2011, Anthem Blue Cross Blue Shield in Ohio implemented a steerage program for imaging services through which company representatives called patients in attempts to redirect them toward lower-cost providers. Within nine months, more than 3,500 patients had been called and steered to different imagers.

In addition, WellPoint launched a passive steerage campaign with OptiNet, an Internet portal through which referring physician were encouraged to schedule patients with lower-cost imagers. When referrers largely ignored this resource, however, WellPoint enlisted RBM company American Imaging Management (AIM) to call patients directly. According to AIM marketing director Ana Perez, nearly 20 percent of patients chose lower-cost imagers in response to the phone calls.

Other payers, such as UnitedHealthcare, also provide radiologist cost information, but they do not actively contact patients. Still other payers successfully steer patients by classifying certain providers as out-of-network in a patient’s insurance plan.

The Impact of Patient Steerage

The increasingly prevalence of patient steerage can potentially impact practices and departments on a variety of levels, McGinty said. According to the ACR-RBMA paper, she said, radiologists should be aware of the three main ways patient steerage can affect everyday practice.

1. Daily operations: When payers redirect patients, providers can lose any time they’ve already spent in the pre-authorization process. They can also experience productivity dips , and if they don’t know patients have been steered elsewhere, they  could face vacant or missed appointment slots. Imagers could  also be asked to answer patient and provider questions about any steerage and why it occurred. Overall, up to 82 percent of RBMA survey respondents indicated steerage decreased their patient volume. However, some respondents — about 14 percent — actually saw volume increases due to patient steerage.

“The big item will be the loss of business, and virtually every practice is looking at a decrease in volumes,” said David Levin, MD, a radiologist with the Center for Research on Utilization of Imaging Services at Thomas Jefferson University. “It’s not like in the early 2000s when volumes were growing like crazy and it wasn’t a problem if we lost a little business because insurance steered our patients elsewhere. No one feels that way anymore.”

2. Legal issues: When payers actively steer patients to lower-cost imaging centers and away from a referring physician’s initial suggestion, they open themselves up to potential medical liability if findings, such as a lung cancer, are missed. In addition, legal action can also be launched against the chosen imager, the imager’s corporation, and the RBM. It’s also possible, especially with active steerage, that these activities violate the federal anti-kickback law that forbids any payments or solicitations that influence patient health decisions.

According to the ACR-RBMA paper, radiologists could also assert payer-directed steerage impedes their legal right to practice, defames their professional reputations by listing them as lower-tiered providers, or violates any existing contracts they have with facilities to receive a certain amount of referrals.

3. Provider relationships: Any payer-directed steerage can disturb existing healthcare relationships, McGinty said. Referring physicians often have a small cadre of imaging providers, chosen for their levels of quality and service, to whom they send patients. Redirecting patients to different imagers can damage long-term provider partnerships and can impose on referrers the additional cost of transferring all patient records to a new imager. Any instances of incomplete reads prompt the need for a second radiological opinion. And, the radiologists providing the second read do not receive reimbursement.

Impact on Patients

While survey data exists to support the negative effect steerage has on providers, the verdict is out on how much payer redirection influences patient care.

The ACR’s biggest concern, McGinty said, is that steerage can confuse patients.

“Patients build relationships with their physicians over time, and they value their doctor’s advice and guidance,” she said. “We don’t want to see those relationships disrupted or see patients’ confidence shaken when it’s suggested they see an imager their doctor didn’t recommend.”

It’s also paramount, she said, to make it clear to patients that payer recommendations are only cost-based suggestions. Many patients are unaware they have a choice to simply pay a higher fee for seeing the imaging provider chosen by their referring physician.

Payer steerage also increases the risk that patients will be sent to a facility without ACR accreditation. But that risk is small, Levin said, adding that ACR accreditation ensures a certain level of service quality.

“I don’t think steerage will impact patient care that much. People will get scans if they need them even if insurance companies steer patients to places they think are more affordable,” he said. “It’s not as if there’s a huge variation in quality so that if you go to my hospital you’ll get a great scan, but if you go to the hospital down the street, you’ll get a lousy one.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/patient-steerage-could-harm-radiologists-confuse-patients

April 25, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Proposed Cuts Lead to Radiology Practice Self-Analysis

Published on the Nov. 14, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When CMS released its 2013 proposed Medicare payment cuts this month, no one in radiology was particularly surprised. Industry experts knew radiology settings and providers faced slashed reimbursement rates, and it’s now time for practices to assess just how affected they might be.

In the fee schedule, set for Jan. 1, 2013, implementation, CMS retained its proposed multiple procedure payment reduction (MPPR) of 25 percent to the professional component (PC) for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice on the same patient, during the same session, on the same day. The Medicare proposed cuts will also decrease overall payments to radiation therapy centers by 9 percent and reduce payments to radiation oncology providers by 7 percent.

Overall reaction, said Maurine S. Dennis, senior director of economics and health policy at the American College of Radiology, is that these proposed reductions are both arbitrary and complicated. The MPPR cut is creating significant angst, she said.

“It’s a cut — a cut to the professional component, so it’s real money out of our providers’ pockets,” she said. “The proposal deals a lot with subspecialists, and it’s complex. It’s going to take time to figure out how everything will shake out.”

The looming 25 percent MPPR cut isn’t the only problem, however, said Mike Mabry, executive director of the Radiology Business Management Association. CMS has also yet to publish any information or guidance about the new coding modifier it plans to implement for same-day, same-provider services. Currently, your coders use the -59 modifier to identify procedures done on the same day that are distinct from all others performed.

In addition, the agency has not released a definition for what it considers to be same-session, leaving practices to determine for themselves how best to process this type of claim. The best course of action, Mabry said, is for practices to conduct a self-assessment of how at-risk they are for MPPR PC payment cuts.

Practices that provide a higher level of tertiary care or other advanced diagnostic imaging services should conduct the most involved analyses of their same-day, same-session services. These settings, he said, will be the most vulnerable to the MPPR PC reduction and will feel the greatest impact on their bottom line.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2114454

November 14, 2012 Posted by | Healthcare, Politics | , , , , , , , , , , , , , | Leave a comment

Radiology Leadership: Proposed Reimbursement Cuts “Arbitrary”

Published on the July 12, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.

CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.

“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”

According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.

The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.

The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.

If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.

There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032

July 13, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

What Health Reform Means for Radiologists

Published on the Aug. 11, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

The health care system as you’ve known it will look drastically different within the next few years, and the radiology industry is set to change with it. If you want to stay afloat and have a competitive practice, you must know which parts of the health reform legislation will affect you and how to handle them.

That’s the message from Robert Still, MD, practice manager for Lancaster Radiology Associates Ltd. in Auburn, Pa. Speaking at the AHRA: The Association for Medical Imaging Management annual meeting in Dallas next week, Still says accountability will be the most important thing to remember as health reform legislation comes online.

“The ways we measure quality in health care and radiology will change. The focus will be higher quality at lower cost,” he said. “As accountable care organizations are introduced, all payments will be bundled and reimbursements will be value based.”

This bundling means you will no longer be reimbursed separately for your services. Instead, your payments will be part of a larger one that includes facility, technical, and physician charges. It could also mean you start assuming a more consultative role in patient care, offering input and making recommendations about which imaging studies are most appropriate, Still said.

This change has industry leaders concerned. They fear policymakers are following MedPAC’s lead in considering bundles or cuts to all the payment codes you use.

“There will be a huge impact in reimbursement if every code is up for grabs,” said Maurine Dennis, senior director of economics and health policy at the American College of Radiology. “Diagnostic radiology is behind the 8-ball and is feeling the biggest impact from reform.”

To read the entire story: http://www.diagnosticimaging.com/healthcare_reform/content/article/113619/1926311?CID=rss&cid=dlvr.it


August 11, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , | Leave a comment


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